Provider Demographics
NPI:1316923329
Name:SAPORITO, JOSEPH JUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JUSTIN
Last Name:SAPORITO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-606-6400
Mailing Address - Fax:903-606-1522
Practice Address - Street 1:2604 SAINT MICHAEL DR
Practice Address - Street 2:STE 345
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2379
Practice Address - Country:US
Practice Address - Phone:903-838-5500
Practice Address - Fax:903-614-6140
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2790207R00000X, 207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200071810AMedicaid
AR3305971OtherBLUE LINK
TX176652902Medicaid
O004252507OtherAETNA
AR158742001Medicaid
AR83618OtherAR BLUE
P00326364OtherRAILROAD
AR158742001Medicaid
OK200071810AMedicaid