Provider Demographics
NPI:1083041966
Name:GORDON P. LAIRD, D.O. INC
Entity Type:Organization
Organization Name:GORDON P. LAIRD, D.O. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:P
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:580-363-0052
Mailing Address - Street 1:39451 E 41 RD
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:OK
Mailing Address - Zip Code:73061-9686
Mailing Address - Country:US
Mailing Address - Phone:580-363-0052
Mailing Address - Fax:580-363-0894
Practice Address - Street 1:534 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:PAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74058-2036
Practice Address - Country:US
Practice Address - Phone:918-762-3602
Practice Address - Fax:580-363-0894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
OK1532208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100128350FMedicaid
OK238228901Medicare PIN