GODDARD, MICHAEL WILLIAM - Licensee Information

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Last Update: Monday, April 29, 2024 11:28 AM CDT
Next Update: Monday, April 29, 2024 4:30 PM CDT

GODDARD, MICHAEL WILLIAM

Practice Address:	COMMUNITY HEALTH SHAWNEE FAMILY MEDICAL CENTER 130 N. BROADWAY STE. # 300 SHAWNEE OK 74801 Address last updated on 6/9/2023
Phone #:	(405) 395-0399
Fax #:	(405) 395-0330
County:	POTTAWATOMIE
License:	10925
Dated:	7/14/1976
Expires:	7/1/2024
License Type:	Medical Doctor
Specialty:	Family Medicine

Status:	Active
Status Class:	Fully Licensed
Restricted to:
Registered to Dispense:	NO
Medical School:	Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated:	/ 1975
CME Year:	2024

Pending and/or Past Disciplinary Actions:

Date

Action

Reasons

Remarks

9/23/2004

License Reinstated

1/29/2004

Suspension, License

Board Filings and/or Orders:
02/12/2004
12/11/2003
12/11/2003

All information below is entered by the licensee but not verified by the Oklahoma Medical Board.

Certifications:
New Patients:	Yes
Medicaid:	Yes
Medicare:	Yes

HMO/PPO:	Aetna PPO Blue Cross Blue Shield-Blue Preferred Blue Cross Blue Shield-Blue Traditional Coventry Health Care National Network Global Health HMO HealthChoice Secure Horizons HMO SoonerCare HMO SoonerCare PPO United Healthcare Choice United Healthcare HMO
Hospital Privileges:	None listed

Locations:	Hours:	Languages:
COMMUNITY HEALTH SHAWNEE FAMILY MEDICAL CENTER 130 N. BROADWAY STE. # 300 SHAWNEE OK 74801 Phone #: (405) 395-0399 Fax #: (405) 395-0330	Mon: 8:30AM - 5:00PM Tue: 8:30AM - 5:00PM Wed: 8:30AM - 5:00PM Thu: 8:30AM - 5:00PM Fri: 8:30AM - 5:00PM Sat: Sun:

Name:	Type:	License Number:
Primary Supervisees(s):
CYNTHIA GUERRERO	APRN	90841
MARTINE NGAMELUE-KOUEMO	APRN	82455