Individual
MR. TOMMY WAYNE LAIRD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5400 CROSSLAKE PKWY, SUITE 300, WACO, TX 76712-6977
(254) 420-2336
(254) 732-0795
Mailing address
5 ADMIRALS CIR, BELTON, TX 76513-6301
(512) 540-1117
(254) 732-0795
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA03396
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00157011
TEXAS DPS REGISTRATION NUMBER
TX
01
—
1034587
NCCPA CERTIFICATION ID NUMBER
—
01
—
PA03396
TEXAS PA LICENSE
TX
Enumeration date
01/05/2007
Last updated
03/07/2023
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