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NPI Code Detail

MEDICARE: EDWARD LAIRD MD PA

MEDICARE: EDWARD LAIRD MD PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianME29033FL

General Provider Information

NPI Number : 1891931242
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDWARD LAIRD MD PA
Provider Business Mailing Address
First Line : 2307 BOLADO PKWY
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-2712
Country : US
Telephone Number : 239-574-6696
Fax Number :
Provider Business Practice Location Address
First Line : 2307 BOLADO PARKWAY
Second Line :
City : CAPE CORAL
State : FL
Zip : 33990-2712
Country : US
Telephone Number : 239-574-6696
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. EDWARD LAIRD
Credential : M.D.
Telephone Number : 239-574-6696
Provider Enumeration Date : 01/06/2009
Last Update Date : 05/07/2009

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