Provider Demographics
NPI:1700991049
Name:LAING, BRENT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:DAVID
Last Name:LAING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-433-6039
Mailing Address - Fax:423-433-6060
Practice Address - Street 1:1505 W ELK AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-2848
Practice Address - Country:US
Practice Address - Phone:423-543-7919
Practice Address - Fax:423-543-5323
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD15696207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNA97587Medicare UPIN
TN3011885Medicare ID - Type Unspecified