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General NPI Number Information
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NPI Number | 1740353598
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Entity Type | Organization
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Legal Business Name | W PENNOCK LAIRD MD PA
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 12201 MERIT DR STE 550
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City | DALLAS
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State | TX
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Zip | 75251
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Country | US
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Telephone | 972-331-9700
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Fax | 972-331-9833
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Provider Business Mailing Address
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Address Line | 12201 MERIT DR STE 550
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City | DALLAS
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State | TX
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Zip | 75251-3131
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Country | US
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Telephone | 972-331-9700
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Fax | 972-331-9833
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | VICKIE J LOOSE
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Credential | CMOM
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Telephone | 972-331-9695
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number |
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License Number State |
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