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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Wednesday, December 18, 2024 6:43 PM CST
Next Update: Thursday, December 19, 2024 2:50 AM CST

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WAGNER, DUSTIN KIYOSHI       
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: INTEGRIS ORTHOPEDIC TRAUMA SURGERY
3433 NW 56TH ST
BLDG B SUITE 900
OKLAHOMA CITY OK 73112

Address last updated on 8/28/2024
Phone #: (405) 713-7035
Fax #:
County: OKLAHOMA
License: 4800
Dated: 8/10/2022
Expires: 3/31/2025
License Type: Physician Assistant
Specialty:
Status: Active
Status Class: Fully Licensed
Restricted to:
CME Year: 2025
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.
Locations: Hours: Languages:
INTEGRIS ORTHOPEDIC TRAUMA SURGERY
3433 NW 56TH ST
BLDG B SUITE 900
OKLAHOMA CITY OK 73112

Phone #: (405) 713-7035
Fax #:

Hospital Privileges:

INTEGRIS Baptist Medical Center
Oklahoma City, OK
INTEGRIS Baptist Portland Ave (fmly Deaconess Hospital)
Oklahoma City, OK
INTEGRIS Canadian Valley Regional Hospital
Yukon, OK
INTEGRIS Edmond
Edmond, OK

Primary Supervisor(s):
Name: Type: License Number: Full/Part Time:
PAUL ROCCO ALLEGRA MD 41076
William Doss DO 6927
ZACHARY MYLES NOLLIN DO 5257

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