Provider Demographics
NPI:1649224791
Name:QUEBEDEAUX-FARNHAM, TERESA LEAH (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:LEAH
Last Name:QUEBEDEAUX-FARNHAM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:TERRI
Other - Middle Name:L
Other - Last Name:QUEBEDEAUX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1055 E HUMPHREY ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155
Mailing Address - Country:US
Mailing Address - Phone:830-303-0005
Mailing Address - Fax:830-379-3348
Practice Address - Street 1:1345 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-3962
Practice Address - Country:US
Practice Address - Phone:830-303-0005
Practice Address - Fax:830-379-3348
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX1246213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX123956801Medicaid
TX00T98LMedicare ID - Type Unspecified
TX123956801Medicaid