Provider Demographics
NPI:1871555250
Name:LAIRD, NATASHA E (MD)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:E
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:PO BOX 6730
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6730
Mailing Address - Country:US
Mailing Address - Phone:480-821-3600
Mailing Address - Fax:480-857-2667
Practice Address - Street 1:37100 N GANTZEL RD
Practice Address - Street 2:STE 106
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7303
Practice Address - Country:US
Practice Address - Phone:480-821-3616
Practice Address - Fax:480-857-2667
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42660207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ475453Medicaid
AZ9010340OtherABOG CERTIFIED
AZBL9461308OtherDEA
AZ475453Medicaid