Provider Demographics
NPI:1639433725
Name:SOTO INTERIANO, EDUARDO FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:FERNANDO
Last Name:SOTO INTERIANO
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 1:41 MONARCH BLVD
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7200
Mailing Address - Country:US
Mailing Address - Phone:612-707-2008
Mailing Address - Fax:
Practice Address - Street 1:41 MONARCH BLVD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7200
Practice Address - Country:US
Practice Address - Phone:612-707-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS24822207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03827532Medicaid