Provider Demographics
NPI:1417255340
Name:PRICE, JACLYN M (DO)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:M
Last Name:PRICE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 E 5TH ST N
Mailing Address - Street 2:NONE
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-2101
Mailing Address - Country:US
Mailing Address - Phone:641-521-7480
Mailing Address - Fax:
Practice Address - Street 1:3701 KATZ DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IA
Practice Address - Zip Code:52302-3871
Practice Address - Country:US
Practice Address - Phone:319-377-3174
Practice Address - Fax:319-377-9368
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04575207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine