Provider Demographics
NPI:1891731733
Name:LAIRD, SHERI LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHERI
Middle Name:LEE
Last Name:LAIRD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 BLANKENSHIP
Mailing Address - Street 2:SUITE 280
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-5101
Mailing Address - Country:US
Mailing Address - Phone:503-496-0290
Mailing Address - Fax:877-921-4101
Practice Address - Street 1:1750 BLANKENSHIP RD
Practice Address - Street 2:SUITE 280
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-5101
Practice Address - Country:US
Practice Address - Phone:503-496-0290
Practice Address - Fax:877-921-4101
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21936207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134282Medicaid
119233Medicare ID - Type Unspecified
H01779Medicare UPIN