Provider Demographics
NPI:1992039960
Name:ALBIN, JACLYN LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:LEWIS
Last Name:ALBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JACLYN
Other - Middle Name:LOUISE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-7201
Mailing Address - Country:US
Mailing Address - Phone:214-645-1460
Mailing Address - Fax:214-648-3161
Practice Address - Street 1:5939 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:214-645-1460
Practice Address - Fax:214-648-3161
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10034544207R00000X, 208000000X
TXP5320208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine