Healthcare Provider Details

I. General information

NPI: 1679673123
Provider Name (Legal Business Name): ROY CLINT LAIRD DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 DEL PRADO BLVD S STE 12
CAPE CORAL FL
33990-5523
US

IV. Provider business mailing address

PO BOX 825159
PHILADELPHIA PA
19182-5159
US

V. Phone/Fax

Practice location:
  • Phone: 239-573-9200
  • Fax: 855-376-5040
Mailing address:
  • Phone: 866-626-1540
  • Fax: 866-386-8526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: