Provider Demographics
NPI:1013477496
Name:SIDRONIO, TALLES BARROSO PINTO DE CAMPOS (MD)
Entity type:Individual
Prefix:
First Name:TALLES BARROSO
Middle Name:PINTO DE CAMPOS
Last Name:SIDRONIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TALLES
Other - Middle Name:
Other - Last Name:SIDRONIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:515 NE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-5465
Mailing Address - Country:US
Mailing Address - Phone:248-798-0480
Mailing Address - Fax:
Practice Address - Street 1:16260 S RANCHO SAHUARITA BLVD
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-0047
Practice Address - Country:US
Practice Address - Phone:520-416-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME162385207L00000X
WAMD61471194207L00000X
AZ75151207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118378600Medicaid
WA2263246Medicaid