Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dustin Wagner, PA

Individual provider Surgical Physician Assistant · NPI 1093453565

Dustin Wagner, PA is a Physician Assistant in Oklahoma City, Oklahoma. Qualified in 2022, 4 years ago. Practices with Integris Ambulatory Care Corporation, a 683-clinician group and accepts Medicare assignment. Licensed in Oklahoma.

Years since qualifying
4
Licensed in
OK
In the registry since
2022
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

5401 N Portland Ave Ste 600
Oklahoma City, OK 73112-2090
Phone: (405) 713-9940
Fax: (405) 713-9941
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 4800 (OK)

Record details

NPI number1093453565
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 24, 2022
Last updated in NPPESJanuary 12, 2023
Certification dateJanuary 12, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Integris Ambulatory Care Corporation — 683 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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