Provider Demographics
NPI:1306834023
Name:LAIRD, WILLIAM PENNOCK II (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PENNOCK
Last Name:LAIRD
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 MERIT DR STE 550
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3131
Mailing Address - Country:US
Mailing Address - Phone:972-331-9700
Mailing Address - Fax:972-331-9833
Practice Address - Street 1:12201 MERIT DR STE 550
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75251
Practice Address - Country:US
Practice Address - Phone:972-331-9700
Practice Address - Fax:972-331-9833
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK35992080P0202X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157506003Medicaid
TX00362RMedicare ID - Type Unspecified
TXH33867Medicare UPIN