Provider Demographics
NPI:1750482097
Name:LAIRD, THADDEUS A
Entity Type:Individual
Prefix:DR
First Name:THADDEUS
Middle Name:A
Last Name:LAIRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 N ARLINGTON AVE
Mailing Address - Street 2:SUITE 250A
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4505
Mailing Address - Country:US
Mailing Address - Phone:775-329-7707
Mailing Address - Fax:775-329-7767
Practice Address - Street 1:645 N ARLINGTON AVE
Practice Address - Street 2:SUITE 250A
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4505
Practice Address - Country:US
Practice Address - Phone:775-329-7707
Practice Address - Fax:775-329-7767
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV66082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016548Medicaid
NV30WCCGD-09Medicare ID - Type Unspecified
NV2016548Medicaid