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General NPI Number Information
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NPI Number | 1619954088
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Entity Type | Individual
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Provider Name | GORDON P LAIRD D.O.
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 09/26/2024
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Provider Practice Location Address
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Address Line | 534 ILLINOIS ST
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City | PAWNEE
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State | OK
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Zip | 74058-2036
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Country | US
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Telephone | 918-762-3602
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Fax | 918-762-2952
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Provider Business Mailing Address
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Address Line | 534 ILLINOIS ST
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City | PAWNEE
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State | OK
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Zip | 74058-2036
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Country | US
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Telephone | 918-762-3602
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Fax | 918-762-2952
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 1532
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 1532
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1532
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License Number State | OK
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