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General NPI Number Information
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NPI Number | 1891931242
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Entity Type | Organization
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Legal Business Name | EDWARD LAIRD MD PA
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Dates
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Enumeration Date | 01/06/2009
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Last Update Date | 05/07/2009
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Provider Practice Location Address
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Address Line | 2307 BOLADO PARKWAY
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City | CAPE CORAL
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State | FL
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Zip | 33990-2712
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Country | US
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Telephone | 239-574-6696
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Fax |
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Provider Business Mailing Address
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Address Line | 2307 BOLADO PKWY
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City | CAPE CORAL
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State | FL
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Zip | 33990-2712
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Country | US
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Telephone | 239-574-6696
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD LAIRD
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Credential | M.D.
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Telephone | 239-574-6696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME29033
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License Number State | FL
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