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General NPI Number Information
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NPI Number | 1679620058
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Entity Type | Individual
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Provider Name | TOMMY WAYNE LAIRD JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 5400 CROSSLAKE PKWY SUITE 300
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City | WACO
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State | TX
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Zip | 76712-6977
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Country | US
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Telephone | 254-420-2336
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Fax | 254-732-0795
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Provider Business Mailing Address
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Address Line | 5 ADMIRALS CIR
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City | BELTON
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State | TX
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Zip | 76513-6301
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Country | US
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Telephone | 512-540-1117
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Fax | 254-732-0795
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA03396
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License Number State | TX
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