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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Saturday, December 21, 2024 6:44 PM CST
Next Update: Sunday, December 22, 2024 2:50 AM CST

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GREENWELL, MARK WILLIAM       
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: THE CENTERS FOR KIDNEY CARE
1104 E LINCOLN RD
IDABEL OK 74745

Address last updated on 9/24/2024
Phone #: (903) 785-3300
Fax #: (903) 785-3310
County: MCCURTAIN
License: 29498
Dated: 10/30/2012
Expires: 10/1/2025
License Type: Medical Doctor
Specialty: Nephrology
Internal Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Univ of TX Med Sch at Houston, Houston Tx 77225
Graduated: 6 / 1999
CME Year: 2027
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 INTERNAL MEDICINE
AMERICAN BOARD OF INTERNAL MEDICINE - Nephrology
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: Blue Cross Blue Shield-Blue Preferred
Blue Cross Blue Shield-Blue Traditional
Blue Cross Blue Shield-Plan 65 Select
BlueChoice PPO
BlueLincs HMO
CIGNA PPO
First Health
HealthChoice
Multiplan PPO
SoonerCare HMO
SoonerCare PPO
Texas Medicaid
United Healthcare EPO
United Healthcare Options PPO
United Healthcare POS
Hospital Privileges: Paris Regional Medical Center
Paris, TX
Locations: Hours: Languages:
THE CENTERS FOR KIDNEY CARE
1104 E LINCOLN RD
IDABEL OK 74745

Phone #: (903) 785-3300
Fax #: (903) 785-3310
Mon:
Tue:
Wed: 9:00AM - 5:00PM
Thu:
Fri:
Sat:
Sun:
635 Stone Avenue
Paris, TX 75460

Phone #: (903) 785-3300
Fax #: (8) 201-
Mon: 8:00AM - 5:00PM
Tue: 8:00AM - 5:00PM
Wed: 8:00AM - 5:00PM
Thu: 8:00AM - 5:00PM
Fri: 8:00AM - 12:00PM
Sat: Closed
Sun: Closed
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
TANGANYIKA DUDLEY APRN 132422

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