Individual
DR. ROGER A. LAIRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EDD
Contact information
Practice address
200 CLINIC DR, MADISONVILLE, KY 42431-1661
(270) 825-6680
(270) 825-7266
Mailing address
2700 STANLEY GAULT PKWY STE 129, LOUISVILLE, KY 40223-5176
(502) 253-4900
(502) 489-5751
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0487
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000261031
BCBS PROVIDER NUMBER
—
01
—
000000787401
BCBS BAPTIST HEALTH
KY
01
—
0487
LICENSE
KY
05
—
89000202
—
KY
Enumeration date
09/17/2006
Last updated
07/11/2019
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