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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

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SIDDIQUI, ANAS AHMED       
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: 3345 TERRITORY LANE
EL RENO OK 73036

Address last updated on 11/2/2024
Phone #: (405) 252-3550
Fax #: (405) 252-3555
County: OKLAHOMA
License: 35271
Dated: 12/5/2019
Expires: 12/1/2025
License Type: Medical Doctor
Specialty: General Practice
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: Dow Med Coll, Univ Of Karachi, Karachi, Pakistan
Graduated: 3 / 2015
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 FAMILY MEDICINE
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: None listed
Hospital Privileges: SSM Health St. Anthony Shawnee Hospital (fmly Unity Health Ctr)
Shawnee, OK
Locations: Hours: Languages:
3345 TERRITORY LANE
EL RENO OK 73036

Phone #: (405) 252-3550
Fax #: (405) 252-3555
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
JILL CACCIABANDO APRN 5639
ROBERT CHARLES DICINTIO PA 564
ZHANNA GOLDKAMP APRN 5870
KEITH ALEX RASMUSSEN PA 1725
KATHERINE SCODARY APRN 12196
ALLISON THORN APRN 1644
SOISANGVANE WINGARD APRN 96349

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