Provider Demographics
NPI:1548416399
Name:LAIRD, PHILIP WALTON (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:WALTON
Last Name:LAIRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3399 PGA BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2819
Mailing Address - Country:US
Mailing Address - Phone:561-624-0099
Mailing Address - Fax:561-624-7373
Practice Address - Street 1:3399 PGA BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2804
Practice Address - Country:US
Practice Address - Phone:561-624-0099
Practice Address - Fax:561-624-7373
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 118738207W00000X
GA66203207W00000X
390200000X
FLME118738207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHW695ZMedicare PIN