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Last Update: Monday, December 23, 2024 3:49 AM CST
Next Update: Monday, December 23, 2024 12:00 PM CST
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DOCKENDORF, JUSTIN GRAHAM
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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.
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| 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
Family Medicine
Addiction Medicine |
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| Status: |
Active |
| Status Class: |
Fully Licensed |
| Restricted to: |
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| Registered to Dispense: |
NO |
| Medical School: |
St George's Univ, Sch Of Med, St George's, Grenada |
| Graduated: |
6 /
2003 |
| CME Year: |
2026 |
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Pending and/or Past Disciplinary Actions:
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| Date |
Action |
Reasons |
Remarks |
| 1/18/2024 |
Completed all requirements ordered by the Board |
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| 9/15/2022 |
Voluntary Submittal to Jurisdiction |
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| 3/30/2022 |
Complaint Citation |
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Board Filings and/or Orders:
09/15/2022
06/29/2022
03/30/2022
03/30/2022
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All information below is entered by the licensee but not verified by the Oklahoma Medical Board.
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| Certifications: |
ABPS - Family Medicine |
| New Patients: |
Yes |
| Medicaid: |
No |
| Medicare: |
No |
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| HMO/PPO: |
None listed |
| Hospital Privileges: |
OU Health Medical Center
Oklahoma City, OK
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