Organization
W PENNOCK LAIRD MD PA
Active
Other names
Pediatric Heart Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE J LOOSE CMOM (PRACTICE ADMINISTRATOR)
(972) 331-9695
Entity
Organization
Contact information
Practice address
12201 MERIT DR STE 550, DALLAS, TX 75251
(972) 331-9700
(972) 331-9833
Mailing address
12201 MERIT DR STE 550, DALLAS, TX 75251-3131
(972) 331-9700
(972) 331-9833
Taxonomy
Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1306834023
NPI
TX
01
—
1417110339
NPI
TX
01
—
1437126364
NPI
TX
01
—
1518955335
NPI
TX
01
—
1548450216
NPI
TX
05
—
1575060003
—
TX
05
—
157508601
—
TX
01
—
1790773513
NPI
TX
05
—
194614707
—
TX
05
—
204311909
—
TX
05
—
212234302
—
TX
05
—
370751501
—
TX
05
—
370765501
—
TX
Enumeration date
11/16/2006
Last updated
08/29/2018
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