Active NPI
Ruth Bertram Laird, PA-C
- Dermatology Physician
- Oklahoma City, OK
National Provider Identifier
1841689510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 2472
- Practice address
- 4805 S Western Ave
Oklahoma City, OK 73109-3835 - Phone
- (405) 636-1506
- Fax
- (405) 636-1511
- NPI assigned
- Jan 17, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2472 | OK | |
| Dermatology Physician | 207N00000X | 2472 | OK | Primary |
Addresses
Primary practice location
4805 S Western Ave
Oklahoma City, OK 73109-3835
Mailing address
4805 S Western Ave
Oklahoma City, OK 73109-3835
Phone (405) 636-1506
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2472 | OK | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522800000000",
"number": "1841689510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4805 S WESTERN AVE",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731093835",
"telephone_number": "405-636-1506",
"fax_number": "405-636-1511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4805 S WESTERN AVE",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731093835",
"telephone_number": "405-636-1506",
"fax_number": "405-636-1511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAIRD",
"first_name": "RUTH",
"middle_name": "BERTRAM",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-17",
"last_updated": "2018-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OK",
"license": "2472",
"primary": false
},
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "OK",
"license": "2472",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.