Provider Demographics
NPI:1528062213
Name:CAPORUSSO, JOSEPH MICHEAL (DPM PA)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHEAL
Last Name:CAPORUSSO
Suffix:
Gender:M
Credentials:DPM PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2930
Mailing Address - Country:US
Mailing Address - Phone:956-971-9107
Mailing Address - Fax:956-971-9109
Practice Address - Street 1:812 LINDBERG AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2930
Practice Address - Country:US
Practice Address - Phone:956-971-9107
Practice Address - Fax:956-971-9109
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1091213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135012605OtherTPI INDIVIDUAL
TX018805401Medicaid
TX157919501Medicaid
TX135012605OtherTPI INDIVIDUAL
TX018805401Medicaid
TX4661430001Medicare NSC