Provider Demographics
NPI:1790711919
Name:LAING, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LAING
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 1:4700 FLANARY
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092
Mailing Address - Country:US
Mailing Address - Phone:903-821-4001
Mailing Address - Fax:903-891-3378
Practice Address - Street 1:1000 SOUTH HERITAGE PKWY
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-891-0949
Practice Address - Fax:903-891-3378
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200017440AMedicaid
TX163515301Medicaid
TXF98026Medicare UPIN
TX163515301Medicaid