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1013477496 NPI number — TALLES BARROSO PINTO DE CAMPOS SIDRONIO MD

NPI Number: 1013477496
Health Care Provider/Practitioner: TALLES BARROSO PINTO DE CAMPOS SIDRONIO MD

Information about “1013477496” NPI (TALLES BARROSO PINTO DE CAMPOS SIDRONIO MD) exists in 1013477496 in HTML format HTML  |  1013477496 in plain Text format TXT  |  1013477496 in PDF (Portable Document Format) PDF  |  1013477496 in an XML format XML  formats.

NPI Number : 1013477496 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1013477496",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SIDRONIO",
    "FirstName": "TALLES BARROSO",
    "MiddleName": "PINTO DE CAMPOS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SIDRONIO",
    "OtherFirstName": "TALLES",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "515 NE BOULEVARD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GAINESVILLE",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32601-5465",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-798-0480",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "602 INDIANA AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LUBBOCK",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "79415-3364",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "806-743-2891",
    "PracticeLocationAddressFaxNumber": "806-743-2984",
    "EnumerationDate": "03/22/2019",
    "LastUpdateDate": "09/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "U4932",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "75151",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "MD61471194",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207L00000X",
          "TaxonomyName": "Anesthesiology Physician",
          "LicenseNumber": "ME162385",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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