Healthcare Provider Details

I. General information

NPI: 1083041966
Provider Name (Legal Business Name): GORDON P. LAIRD, D.O. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 ILLINOIS ST
PAWNEE OK
74058-2036
US

IV. Provider business mailing address

534 ILLINOIS ST
PAWNEE OK
74058-2036
US

V. Phone/Fax

Practice location:
  • Phone: 918-762-3602
  • Fax: 187-622-9529
Mailing address:
  • Phone: 918-762-3602
  • Fax: 918-762-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1532
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GORDON P LAIRD
Title or Position: OWNER
Credential: D.O.
Phone: 580-363-0052