Provider Demographics
NPI:1528291986
Name:LAIRD, DONALD DAVID JR (PA-C)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:DAVID
Last Name:LAIRD
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1116
Mailing Address - Country:US
Mailing Address - Phone:517-404-3955
Mailing Address - Fax:
Practice Address - Street 1:1650 RAMBLEWOOD DR
Practice Address - Street 2:STE 100
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-7396
Practice Address - Country:US
Practice Address - Phone:517-332-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1966887363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant