Provider Demographics
NPI:1578684569
Name:TALOSIG, PEDRO P (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:P
Last Name:TALOSIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 S WINFREE ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-2942
Mailing Address - Country:US
Mailing Address - Phone:936-258-2426
Mailing Address - Fax:936-258-2488
Practice Address - Street 1:402 S WINFREE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2942
Practice Address - Country:US
Practice Address - Phone:936-258-2426
Practice Address - Fax:936-258-2488
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115356102Medicaid
TX00KT81Medicare PIN
TXB26853Medicare UPIN