Healthcare Provider Details

I. General information

NPI: 1477758050
Provider Name (Legal Business Name): JACLYN F HILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 09/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 FANNIN ST STE 660 MS CCC660
HOUSTON TX
77030-2610
US

IV. Provider business mailing address

6701 FANNIN ST STE 660 MS CCC660
HOUSTON TX
77030-2610
US

V. Phone/Fax

Practice location:
  • Phone: 832-822-3100
  • Fax: 832-825-9019
Mailing address:
  • Phone: 832-822-3100
  • Fax: 832-825-9019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberP4457
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: