Individual
DR. JOHN A QUERALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0312
(817) 317-7033
Mailing address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0404
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
H8342
TX
2085R0204X
Vascular & Interventional Radiology Physician
H8342
TX
2085U0001X
Diagnostic Ultrasound Physician
H8342
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134468105
—
TX
01
—
H8342
TEXAS LICENSE
TX
Enumeration date
02/03/2006
Last updated
09/23/2019
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