Healthcare Provider Details

I. General information

NPI: 1811953268
Provider Name (Legal Business Name): CAMILLE BRIDGET CARROLL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAMILLE BRIDGET GOFF MD

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 WOODWAY #369W
HOUSTON TX
77056
US

IV. Provider business mailing address

4801 WOODWAY DR STE 369W
HOUSTON TX
77056-1892
US

V. Phone/Fax

Practice location:
  • Phone: 713-622-7060
  • Fax: 713-622-7093
Mailing address:
  • Phone: 713-622-7060
  • Fax: 713-622-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberH6241
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: