# PAWNEE HEALTH & WELLNESS CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174892590
- **Authorized official:** DR. GORDON PAGE LAIRD D.O. (OWNER)
- **Authorized official phone:** (918) 762-3601

## Contact information

- **Practice address:** 304 BOULDER ST, PAWNEE, OK 74058-4028
- **Practice address phone:** (918) 762-3601
- **Practice address fax:** (918) 762-2544
- **Mailing address:** 304 BOULDER ST, PAWNEE, OK 74058-4028
- **Mailing address phone:** (918) 762-3601
- **Mailing address fax:** (918) 762-2544

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | OK1532 | OK | Yes |
| 363A00000X | Physician Assistant | PA763 | OK | — |

## Other

- **Enumeration date:** 12/14/2011
- **Last updated:** 04/05/2012