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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Friday, November 22, 2024 6:42 PM CST
Next Update: Saturday, November 23, 2024 2:50 AM CST

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DOCKENDORF, JUSTIN GRAHAM       
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: 1725 SIGNAL RIDGE DR.
SUITE #130
EDMOND OK 73013-3790

Address last updated on 10/28/2024
Phone #: (405) 706-3019
Fax #: (405) 471-5750
County: OKLAHOMA
License: 23662
Dated: 9/20/2005
Expires: 9/1/2025
License Type: Medical Doctor
Specialty: Emergency Medicine
Addiction Medicine
Family Medicine
Status: Active
Status Class: Fully Licensed
Restricted to:
Registered to Dispense: NO
Medical School: St George's Univ, Sch Of Med, St George's, Grenada
Graduated: 6 / 2003
CME Year: 2026
Pending and/or Past Disciplinary Actions:
Date Action Reasons Remarks
1/18/2024 Completed all requirements ordered by the Board
9/15/2022 Voluntary Submittal to Jurisdiction
3/30/2022 Complaint Citation
Board Filings and/or Orders:
09/15/2022
06/29/2022
03/30/2022
03/30/2022
All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
Certifications: ABPS - Family Medicine
New Patients: Yes
Medicaid: No
Medicare: No
   
HMO/PPO: None listed
Hospital Privileges: OU Health Medical Center
Oklahoma City, OK
Locations: Hours: Languages:
1725 SIGNAL RIDGE DR.
SUITE #130
EDMOND OK 73013-3790

Phone #: (405) 706-3019
Fax #: (405) 471-5750
Mon: BY. APPT
Tue: BY APPT.
Wed: BY APPT.
Thu: BY APPT.
Fri: BY APPT
Sat: BY. APPT
Sun: BY APPT.
Primary Supervisees(s):
Name: Type: License Number: Full/Part Time:
CHESTER ALAN HENDERSHOT JR. PA 2821
HASSAN M KARIM PA 2353

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