Provider Demographics
NPI:1639152465
Name:LAIRD, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:LAIRD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:9370 SW GREENBURG RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5442
Mailing Address - Country:US
Mailing Address - Phone:503-244-8601
Mailing Address - Fax:503-244-8738
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:STE 445
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:503-231-0166
Practice Address - Fax:503-231-2720
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-25
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
ORMD09572207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR111344Medicaid
ORC909020Medicare UPIN
OR111344Medicaid