Provider Demographics
NPI:1306209119
Name:HARBISON, ALICIA JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:JEAN
Last Name:HARBISON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:JEAN
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2206 W PARK ROW DR STE 102
Mailing Address - Street 2:
Mailing Address - City:PANTEGO
Mailing Address - State:TX
Mailing Address - Zip Code:76013-3404
Mailing Address - Country:US
Mailing Address - Phone:817-860-2700
Mailing Address - Fax:817-860-2704
Practice Address - Street 1:2206 W PARK ROW DR STE 102
Practice Address - Street 2:
Practice Address - City:PANTEGO
Practice Address - State:TX
Practice Address - Zip Code:76013-3404
Practice Address - Country:US
Practice Address - Phone:987-817-2870
Practice Address - Fax:987-817-2869
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS2055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty