Healthcare Provider Details

I. General information

NPI: 1619070414
Provider Name (Legal Business Name): JUSTIN GRAHAM DOCKENDORF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 N CZECH HALL RD
YUKON OK
73099-7897
US

IV. Provider business mailing address

3100 DUTCH FOREST LN
EDMOND OK
73013-7577
US

V. Phone/Fax

Practice location:
  • Phone: 405-494-8600
  • Fax: 405-494-8567
Mailing address:
  • Phone: 405-706-3019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23662
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: