Healthcare Provider Details

I. General information

NPI: 1942615489
Provider Name (Legal Business Name): OSVALDO J LAURIDO SOTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROGRESS POINT PKWY STE 200
O FALLON MO
63368-2207
US

IV. Provider business mailing address

'PO BOX 959203 ST LOUIS MO 63195'
SAINT LOUIS MO
63195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 636-916-7060
  • Fax: 636-916-9421
Mailing address:
  • Phone: 636-916-7060
  • Fax: 636-916-9421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2018005487
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: