Provider Demographics
NPI:1336721885
Name:PERALTA, JOAQUIN ALBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:ALBERTO
Last Name:PERALTA
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 1:4835 LYNDON B JOHNSON FWY STE 900
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6001
Mailing Address - Country:US
Mailing Address - Phone:281-948-8275
Mailing Address - Fax:
Practice Address - Street 1:4835 LYNDON B JOHNSON FWY STE 900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-6001
Practice Address - Country:US
Practice Address - Phone:281-948-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-24
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCPERA-DQXK4L207P00000X
TXU9633207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty