Provider Demographics
NPI:1093835712
Name:JOHN M LAIRD INC
Entity Type:Organization
Organization Name:JOHN M LAIRD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:314-872-3620
Mailing Address - Street 1:3009 N BALLAS ROAD
Mailing Address - Street 2:SUITE 230A
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2322
Mailing Address - Country:US
Mailing Address - Phone:314-872-3620
Mailing Address - Fax:314-872-9003
Practice Address - Street 1:3009 N BALLAS ROAD
Practice Address - Street 2:SUITE 230A
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-872-3620
Practice Address - Fax:314-872-9003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOM028214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO100848OtherHEALTHLINK
MO000015664OtherMEDICARE PTAN
MO110234947OtherRAILROAD MEDICARE
MSA11522Medicare UPIN