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Oklahoma Board of Medical Licensure and Supervision

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Last Update: Sunday, April 28, 2024 1:44 PM CDT
Next Update: Sunday, April 28, 2024 4:30 PM CDT

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WAGNER, DUSTIN KIYOSHI
Practice Address: INTEGRIS ORTHOPEDIC CENTRAL
5401 N PORTLAND AVE
SUITE 600
OKLAHOMA CITY OK 73112

Address last updated on 2/5/2024
Phone #: (405) 713-9940
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 CENTRAL
5401 N PORTLAND AVE
SUITE 600
OKLAHOMA CITY OK 73112

Phone #: (405) 713-9940
Fax #:

Hospital Privileges:

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

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

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