Provider Demographics
NPI:1063568749
Name:LAIRD, REBECCA E (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:LAIRD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:377 SYLVAN LAKE ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EAGLE
Mailing Address - State:CO
Mailing Address - Zip Code:81631
Mailing Address - Country:US
Mailing Address - Phone:970-328-1650
Mailing Address - Fax:970-926-0850
Practice Address - Street 1:318 BROADWAY X5850
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631-5850
Practice Address - Country:US
Practice Address - Phone:970-926-6350
Practice Address - Fax:970-926-6355
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2013-08-16
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Provider Licenses
StateLicense IDTaxonomies
CO42181207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063568749OtherNPI
CO39736814Medicaid
COCO303497Medicare PIN
CO39736814Medicaid