Provider Demographics
NPI:1720296007
Name:FERGUSON, TERESA MOSQUEDA (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MOSQUEDA
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:VASQUEZ
Other - Last Name:MOSQUEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1600 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-784-5181
Mailing Address - Fax:916-784-5770
Practice Address - Street 1:1600 EUREKA RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3027
Practice Address - Country:US
Practice Address - Phone:916-784-5181
Practice Address - Fax:916-784-5770
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR-7403207X00000X
MO2012015967207XP3100X
CAA106151207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO784611OtherANTHEM BLUE CROSS BLUE SHIELD
MO784611OtherANTHEM BLUE CROSS BLUE SHIELD