Healthcare Provider Details

I. General information

NPI: 1013477496
Provider Name (Legal Business Name): TALLES BARROSO PINTO DE CAMPOS SIDRONIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TALLES SIDRONIO MD

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415-3364
US

IV. Provider business mailing address

515 NE BOULEVARD
GAINESVILLE FL
32601-5465
US

V. Phone/Fax

Practice location:
  • Phone: 806-743-2891
  • Fax: 806-743-2984
Mailing address:
  • Phone: 248-798-0480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberU4932
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number75151
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD61471194
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME162385
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: