Provider Demographics
NPI:1659376572
Name:BARRIOS OGDEN, TERESA (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:BARRIOS OGDEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12042 BLANCO RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5440
Mailing Address - Country:US
Mailing Address - Phone:210-341-4183
Mailing Address - Fax:210-341-3831
Practice Address - Street 1:12042 BLANCO RD
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5440
Practice Address - Country:US
Practice Address - Phone:210-341-4183
Practice Address - Fax:210-341-3831
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2014-11-12
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
TX0925P213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87M511OtherBLUE CROSS/BLUE SHIELD
TX0528390001OtherPALMETTO DME
TX4369815OtherAETNA
TX121578204Medicaid
TX00J36AMedicare PIN
TX4369815OtherAETNA