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General NPI Number Information
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NPI Number | 1912364266
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Entity Type | Organization
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Legal Business Name | STACEY LAIRD, MD, LLC
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Dates
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Enumeration Date | 01/18/2016
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Last Update Date | 01/18/2016
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Provider Practice Location Address
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Address Line | 4121 W 83RD ST STE. 204
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City | PRAIRIE VILLAGE
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State | KS
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Zip | 66208-5472
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Country | US
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Telephone | 913-222-4498
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Fax | 913-273-6224
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Provider Business Mailing Address
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Address Line | 6801 BELINDER AVE
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City | MISSION HILLS
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State | KS
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Zip | 66208-2258
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Country | US
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Telephone | 913-222-4498
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Fax | 913-273-6224
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Authorized Official
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Title or Position | OWNER
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Name | STACEY LAIRD
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Credential | MD
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Telephone | 913-222-4498
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0438502
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License Number State | KS
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