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General NPI Number Information
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NPI Number | 1285926659
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Entity Type | Individual
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Provider Name | JUSTIN D SACKS M.D
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Gender | Male
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 11/18/2020
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Provider Practice Location Address
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Address Line | 627 TURTLE CREEK DR
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City | TYLER
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State | TX
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Zip | 75701
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Country | US
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Telephone | 903-593-2539
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Fax | 903-593-0559
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Provider Business Mailing Address
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Address Line | 816 W CANNON ST
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City | FORT WORTH
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State | TX
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Zip | 76104-3146
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Country | US
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Telephone | 817-321-0404
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | P4240
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License Number State | TX
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