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Individual

MARK V. QUERALT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
3724 EXECUTIVE CENTER DR, SUITE G-10, AUSTIN, TX 78731-1646
(512) 345-5925
(512) 343-7113
Mailing address
3724 EXECUTIVE CENTER DR, SUITE G-10, AUSTIN, TX 78731-1646
(512) 345-5925
(512) 343-7113

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
J4456
TX
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
J4456
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036787202
TX
05
036787203
TX
01
8CV460
BCBS
TX
Enumeration date
08/10/2006
Last updated
01/23/2013
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