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MORADIAN, GLENN PETER       
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: ADVANCED DIAGNOSTIC RADIOLOGY
2060 SOUTH WOODRUFF
IDAHO FALLS ID 83404

Address last updated on 10/3/2007
Phone #: (208) 557-0999
Fax #:
County: NOT OKLAHOMA
License: 25957
Dated: 10/3/2007
Expires: 10/1/2008
License Type: Medical Doctor
Specialty: Diagnostic Radiology
Status: Inactive
Status Class: Expired License
Restricted to:
Registered to Dispense: NO
Medical School: Univ Of NC Chapel Hill Sch Of Med, Chapel Hill Nc 27599
Graduated: 5 / 1983
CME Year: 2010
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 RADIOLOGY
New Patients: Contact licensee
Medicaid: Contact licensee
Medicare: Contact licensee
   
HMO/PPO: None listed
Hospital Privileges: None listed
Locations: Hours: Languages:
ADVANCED DIAGNOSTIC RADIOLOGY
2060 SOUTH WOODRUFF
IDAHO FALLS ID 83404

Phone #: (208) 557-0999
Fax #:

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