Provider Demographics
NPI:1609953892
Name:LAIRD, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:LAIRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:921 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3264
Mailing Address - Country:US
Mailing Address - Phone:805-473-4949
Mailing Address - Fax:808-473-3165
Practice Address - Street 1:921 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3264
Practice Address - Country:US
Practice Address - Phone:805-476-4949
Practice Address - Fax:808-473-3165
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78037207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG780370Medicaid
CAF84264Medicare UPIN