Provider Demographics
NPI:1760616163
Name:HARRISON, JACLYN HERFARTH (MD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:HERFARTH
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:AILINE
Other - Last Name:HERFARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1900 NORTH LOOP W STE 580
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8163
Mailing Address - Country:US
Mailing Address - Phone:713-714-5376
Mailing Address - Fax:713-325-0759
Practice Address - Street 1:1900 NORTH LOOP W STE 580
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8163
Practice Address - Country:US
Practice Address - Phone:713-714-5376
Practice Address - Fax:713-325-0759
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4061207R00000X
DCMD039220208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine