Provider Demographics
NPI:1982792479
Name:LAIR, TANYA JAY (PA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:JAY
Last Name:LAIR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6615 DEER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75442-5101
Mailing Address - Country:US
Mailing Address - Phone:972-853-0444
Mailing Address - Fax:972-853-0424
Practice Address - Street 1:440 STATE HIGHWAY 78
Practice Address - Street 2:SUITE 220
Practice Address - City:LAVON
Practice Address - State:TX
Practice Address - Zip Code:75166-1265
Practice Address - Country:US
Practice Address - Phone:972-853-0444
Practice Address - Fax:972-853-0424
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA02844363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP73808Medicare UPIN
TX8F2233Medicare PIN
TX84P416Medicare ID - Type Unspecified