Provider Demographics
NPI:1073047601
Name:HARRIS, JACLYN (DO)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:HARRIS
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 1:5151 E BROADWAY BLVD STE 1600
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3777
Mailing Address - Country:US
Mailing Address - Phone:623-404-2244
Mailing Address - Fax:623-304-1312
Practice Address - Street 1:5151 E BROADWAY BLVD STE 1600
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3777
Practice Address - Country:US
Practice Address - Phone:623-404-2244
Practice Address - Fax:623-304-1312
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1408207R00000X
AZ010864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine