Provider Demographics
NPI:1720322175
Name:JASON M LAIRD, MD LLC
Entity type:Organization
Organization Name:JASON M LAIRD, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-568-0160
Mailing Address - Street 1:PO BOX 8418
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96830-0418
Mailing Address - Country:US
Mailing Address - Phone:808-568-0160
Mailing Address - Fax:808-568-0160
Practice Address - Street 1:1029 KAPAHULU AVE STE 309
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-1332
Practice Address - Country:US
Practice Address - Phone:808-568-0160
Practice Address - Fax:808-568-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-23
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC194088Medicaid
SC7813Medicare PIN
H07060Medicare UPIN