Individual
MATTHEW SOTHERAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1601 WENTZVILLE PKWY STE 117, WENTZVILLE, MO 63385-3814
(636) 332-8477
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-2551
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2019046725
MO
363A00000X
Physician Assistant
—
—
Other
Enumeration date
12/29/2019
Last updated
10/27/2020
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