WAYNE, IVAN - Licensee Information - Oklahoma Medical Board

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Last Update: Wednesday, May 1, 2024 5:08 PM CDT
Next Update: Thursday, May 2, 2024 2:50 AM CDT

WAYNE, IVAN

Practice Address:	10001 BROADWAY EXTENSION SUITE A OKLAHOMA CITY OK 73114 Address last updated on 6/19/2023
Phone #:	(405) 748-5950
Fax #:	(405) 607-3580
County:	OKLAHOMA
License:	22995
Dated:	7/16/2002
Expires:	7/1/2024
License Type:	Medical Doctor
Specialty:	Otolaryngology Plastic Surgery within the Head & Neck

Status:	Active
Status Class:	Fully Licensed
Restricted to:
Registered to Dispense:	YES
Medical School:	Univ of IA Roy J & L Carver COM, Iowa City, IA 52242
Graduated:	5 / 1996
CME Year:	2026

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:	ABPS - Plastic & Reconstructive Surgery AMERICAN BOARD OF OTOLARYNGOLOGY AMERICAN BOARD OF OTOLARYNGOLOGY - Plastic Surgery Within the Head and Neck
New Patients:	Yes
Medicaid:	No
Medicare:	Yes

HMO/PPO:	Aetna Elect Choice Aetna HMO Aetna Managed Choice Aetna PPO Beechstreet 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 CommunityCare HMO, Inc Coventry Health Care National Network First Health Global Health HMO HealthChoice Humana ChoiceCare Multiplan PPO Oklahoma Health Network PPO OSMA Health (formerly Plico PPO) PHCS (Private Healthcare Systems) Physicians Direct Network PPO Oklahoma PPO USA Preferred Community Choice Preferred Health Network-ppoNEXT Private Healthcare Systems (PHCS) Railroad Medicare Tricare for Life Tricare Standard United Healthcare Choice United Healthcare EPO United Healthcare HMO United Healthcare Options PPO
Hospital Privileges:	Community Hospital - OKC Oklahoma City, OK Northwest Surgical Hospital Oklahoma City, OK Oklahoma Surgicare Oklahoma City, OK OU Medical Center Oklahoma City, OK Surgery Center of Oklahoma Oklahoma City, OK

Locations:	Hours:	Languages:
10001 BROADWAY EXTENSION SUITE A OKLAHOMA CITY OK 73114 Phone #: (405) 748-5950 Fax #: (405) 607-3580	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: Sun:

Name:	Type:	License Number:
Primary Supervisees(s):
PETER LYNN GRAY	PA	318
MERRY MATHEW THENMADATHIL	PA	1857