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NPI Code Detail

MEDICARE: JUSTIN GRAHAM DOCKENDORF MD

MEDICARE: JUSTIN GRAHAM DOCKENDORF MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician23662OK

General Provider Information

NPI Number : 1619070414
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN GRAHAM DOCKENDORF MD
Provider Business Mailing Address
First Line : 3100 DUTCH FOREST LN
Second Line :
City : EDMOND
State : OK
Zip : 73013-7577
Country : US
Telephone Number : 405-706-3019
Fax Number :
Provider Business Practice Location Address
First Line : 709 N CZECH HALL RD
Second Line :
City : YUKON
State : OK
Zip : 73099-7897
Country : US
Telephone Number : 405-494-8600
Fax Number : 405-494-8567
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/07/2006
Last Update Date : 12/18/2025

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Directions to “ JUSTIN GRAHAM DOCKENDORF MD” Practice Location

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