Provider Demographics
NPI:1790773513
Name:LAIRD, WILLIAM PENNOCK (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PENNOCK
Last Name:LAIRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7777 FOREST LANE C855
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2561
Mailing Address - Country:US
Mailing Address - Phone:972-331-9700
Mailing Address - Fax:972-331-9833
Practice Address - Street 1:7777 FOREST LANE C855
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2561
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:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1645174400000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157503701Medicaid
TX157503701Medicaid
TXE80954Medicare UPIN