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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Thursday, December 19, 2024 3:44 AM CST
Next Update: Thursday, December 19, 2024 12:00 PM CST

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BUCKLEY, DUSTAN PIERCE       
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: 9100 N. MAY AVE
OKLAHOMA CITY OK 73120

Address last updated on 6/15/2023
Phone #: (405) 840-4456
Fax #: (405) 840-4295
County: OKLAHOMA
License: 18504
Dated: 7/1/1993
Expires: 7/1/2025
Training Issued: 6/26/1992
Training Expires: 6/30/1993
License Type: Medical Doctor
Specialty: Internal Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: YES
Medical School: Univ Of Ok Coll Of Med, Oklahoma City Ok 73190
Graduated: 6 / 1992
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
New Patients: Yes
Medicaid: Yes
Medicare: Yes
   
HMO/PPO: Blue Cross Blue Shield-Blue Preferred
Blue Cross Blue Shield-Blue Traditional
OSMA Health (formerly Plico PPO)
Hospital Privileges: Mercy Hospital OKC
Oklahoma City, OK
Locations: Hours: Languages:
9100 N. MAY AVE
OKLAHOMA CITY OK 73120

Phone #: (405) 840-4456
Fax #: (405) 840-4295
Mon:
Tue:
Wed:
Thu:
Fri:
Sat:
Sun:
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
MICHELLE ELLENBURG APRN 102324
CARA PANAS APRN 96358

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