Provider Demographics
NPI:1396925541
Name:CARUTHERS, LAIRD DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:LAIRD
Middle Name:DAVID
Last Name:CARUTHERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15301 TYLER FOOTE RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9318
Mailing Address - Country:US
Mailing Address - Phone:530-292-3478
Mailing Address - Fax:530-292-4296
Practice Address - Street 1:15301 TYLER FOOTE RD
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-9318
Practice Address - Country:US
Practice Address - Phone:530-292-3478
Practice Address - Fax:530-292-4296
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38245207Q00000X
ARC-6389207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARC-6389OtherSTATE MEDICAL LICENSE
AR117581749Medicaid
TN38245OtherSTATE MEDICAL LICENSE
TN38245OtherSTATE MEDICAL LICENSE
TN38245OtherSTATE MEDICAL LICENSE