Individual provider Active NPI

Laura Marie Viero-Dothage, MD

  • Emergency Medicine Physician
  • Bridgeton, MO
National Provider Identifier
1124000633
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
2004001493 Issued in MO
Practice address
12303 Depaul Dr
Depaul Health Center
Bridgeton, MO 63044
Phone
(314) 344-6000
Fax
(630) 734-1560
NPI assigned
Nov 18, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 2004001493 MO Primary

Addresses

Primary practice location

12303 Depaul Dr
Depaul Health Center
Bridgeton, MO 63044

Mailing address

PO Box 4853
Dept 4036
Oak Brook, IL 60522-4853
Phone (630) 734-0200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041028000591 MO Practitioner - Emergency Medicine 9032171442 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2004001493MOMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic East Communities CurrentSince Mar 1, 2020 Accepting new patients
Mercy Clinic East Communities CurrentSince Mar 1, 2020 Accepting new patients
Mercy East Ambulatory Services LLC CurrentSince Jun 13, 2018 Accepting new patients
Midwest Emergency Associates-Fenton, LLC Emergency Medicine Past Accepting new patients

Locations

1015 Bowles Ave
Fenton, MO 63026
Phone (636) 496-2000

409 Lafayette Ctr
Manchester, MO 63011
Phone (636) 707-0764

621 S New Ballas Rd
Ste 4017B
Saint Louis, MO 63141
Phone (314) 872-9192

10010 Kennerly Rd
Saint Louis, MO 63128
Phone (314) 525-1328

11445 Olive Blvd
Saint Louis, MO 63141
Phone (314) 428-9543

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1124000633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4853",
            "address_2": "DEPT 4036",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605224853",
            "telephone_number": "630-734-0200",
            "fax_number": "630-734-1560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12303 DEPAUL DR",
            "address_2": "DEPAUL HEALTH CENTER",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "63044",
            "telephone_number": "314-344-6000",
            "fax_number": "630-734-1560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIERO-DOTHAGE",
        "first_name": "LAURA",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-18",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2004001493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

Verify at the official NPI Registry.