Healthcare Provider Details

I. General information

NPI: 1235190570
Provider Name (Legal Business Name): LAIRD HENRY VERMONT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 04/18/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 N NEW BALLAS CT STE 205
SAINT LOUIS MO
63141-7134
US

IV. Provider business mailing address

PO BOX 7412065
CHICAGO IL
60674-2065
US

V. Phone/Fax

Practice location:
  • Phone: 314-859-4460
  • Fax: 833-740-4372
Mailing address:
  • Phone: 314-859-4460
  • Fax: 833-740-4372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number109831
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: