Provider Demographics
NPI:1770655466
Name:LAIRD, ROBERT THOMAS (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:THOMAS
Last Name:LAIRD
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5941
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-5941
Mailing Address - Country:US
Mailing Address - Phone:325-668-3783
Mailing Address - Fax:325-695-3908
Practice Address - Street 1:2217 S DANVILLE DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4719
Practice Address - Country:US
Practice Address - Phone:325-668-3783
Practice Address - Fax:325-695-3908
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237144367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00SD644Medicare ID - Type Unspecified