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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Friday, November 22, 2024 6:42 PM CST
Next Update: Saturday, November 23, 2024 2:50 AM CST

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PONDER, COREY EUGENE       
This verification service provides current data extracted by the Oklahoma State Board of Medical Licensure and Supervision (OSBMLS) from its own database. The data enclosed in the green box below is provided by and controlled entirely by the OSBMLS and therefore constitutes a primary source verification of licensure status as authentic as a direct inquiry to the OSBMLS. NPI# and hospital privileges (if any) are provided by the licensee and not verified.
Practice Address: 13401 N WESTERN AVE.
STE. 301
OKLAHOMA CITY OK 73114

Address last updated on 5/2/2024
Phone #: (405) 218-2530
Fax #:
County: OKLAHOMA
License: 22884
Dated: 6/1/2004
Expires: 6/1/2025
License Type: Medical Doctor
Specialty: Orthopedic Surgery
Adult Reconstructive Orthopedics
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: YES
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 6 / 2002
CME Year: 2025
Pending and/or Past Disciplinary Actions: No Disciplinary Action Taken.
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications: AMERICAN BOARD OF ORTHOPAEDIC SURGERY
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: Aetna Elect Choice
Aetna HMO
Aetna Managed Choice
Aetna PPO
Beechstreet PPO
Blue Cross Blue Shield-Blue Preferred
Blue Cross Blue Shield-Blue Traditional
Blue Cross Blue Shield-Plan 65 Select
BlueChoice PPO
BlueLincs HMO
CCN Managed Care
Champ VA
CIGNA HMO
CIGNA PPO
CommunityCare HMO, Inc
Coventry Health Care National Network
Dept of Rehabilitation Services (DRS)
Evolutions Healthcare
First Health
Galaxy Health Network
Global Health HMO
Great West Healthcare
Guidestar Health Systems
Health Payors Organization (HPO)
Health Smart Preferred Care (HSPC)
HealthChoice
Heartland Health Plan of Oklahoma
Humana ChoiceCare
Humana Medicare Advantage PPO
Humana Tricare/PGBA
Medicare Blue
Multiplan PPO
Oklahoma Health Network PPO
OSMA Health (formerly Plico PPO)
Pacificare Commercial HMO
PacifiCare of Oklahoma, Inc
PHCS (Private Healthcare Systems)
Physicians Direct Network
PPO Oklahoma
PPO USA
Preferred Community Choice
Preferred Health Network-ppoNEXT
Private Healthcare Systems (PHCS)
Railroad Medicare
Secure Horizons HMO
SoonerCare HMO
SoonerCare PPO
Tricare for Life
Tricare Standard
UniCare Health Plans of Oklahoma
United Healthcare Choice
United Healthcare EPO
United Healthcare HMO
United Healthcare Options PPO
United Healthcare POS
United Insurance
Welcor/Sooner
Worknet of Oklahoma
Hospital Privileges: SSM Health Bone and Joint Hospital at St. Anthony
Oklahoma City, OK
SSM Health St. Anthony Hospital - OKC
Oklahoma City, OK
Locations: Hours: Languages:
13401 N WESTERN AVE.
STE. 301
OKLAHOMA CITY OK 73114

Phone #: (405) 218-2530
Fax #:
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
608 NW 9th
Suite 6000
Oklahoma City, OK 73102

Phone #: (405) 360-6764
Fax #: (1) 201-
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
BEAU JAMES BURTON PA 2526
MORGAN AMANDA GOSSEN PA 2462
KALIN T HEATON PA 4673
MARK DANIEL JOHNSON PA 485
HEATHER COLLIGAN KUKLINSKI PA 1405
GRANT DAVID ROBERTS PA 1204
ROBERT B ROGERS PA 1242
MICHAEL LYNN SANDERSON PA 1808
TAYLOR PAIGE TAMAGE PA 4633

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