Provider Demographics
NPI:1174523450
Name:SOTO, LEROY T (MD)
Entity type:Individual
Prefix:MR
First Name:LEROY
Middle Name:T
Last Name:SOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:203 WOODLAND PARK
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2007
Mailing Address - Country:US
Mailing Address - Phone:512-869-7310
Mailing Address - Fax:512-869-5616
Practice Address - Street 1:3721 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2401
Practice Address - Country:US
Practice Address - Phone:512-869-7310
Practice Address - Fax:512-869-5616
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG5632208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B9949Medicare ID - Type Unspecified
TXA88265Medicare UPIN