IDSTROM, MARK EDMAN - Licensee Information - Oklahoma Medical Board

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Last Update: Monday, April 22, 2024 6:57 PM CDT
Next Update: Tuesday, April 23, 2024 2:50 AM CDT

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IDSTROM, MARK EDMAN

Practice Address:	EDMOND MEMORIAL HOSPITAL 1 SOUTH BRYANT EDMOND OK 73134
Phone #:
Fax #:
County:	OKLAHOMA
License:	12930
Dated:	10/3/1980
Expires:	6/30/1989
License Type:	Medical Doctor
Specialty:	Diagnostic Radiology Other Specialty

Status:	Inactive
Status Class:	Expired License
Restricted to:
Registered to Dispense:	NO
Medical School:	UNIV OF MN MED SCH, MINNEAPOLIS MN 55455
Graduated:	6 / 1975
CME Year:

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:
EDMOND MEMORIAL HOSPITAL 1 SOUTH BRYANT EDMOND OK 73134 Phone #: Fax #:

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Oklahoma State Board of Medical Licensure and Supervision :: 101 NE 51st St, Oklahoma City, OK 73105-1821
Main Number: (405) 962-1400 :: Fax: (405) 962-1440 :: Complaints outside 405 area code: 1-800-381-4519
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