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General NPI Number Information
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NPI Number | 1619070414
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Entity Type | Individual
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Provider Name | JUSTIN GRAHAM DOCKENDORF MD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 709 N CZECH HALL RD
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City | YUKON
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State | OK
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Zip | 73099-7897
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Country | US
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Telephone | 405-494-8600
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Fax | 405-494-8567
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Provider Business Mailing Address
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Address Line | 3100 DUTCH FOREST LN
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City | EDMOND
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State | OK
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Zip | 73013-7577
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Country | US
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Telephone | 405-706-3019
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 23662
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License Number State | OK
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