Healthcare Provider Details

I. General information

NPI: 1104078781
Provider Name (Legal Business Name): CAROLINE ELIZABETH CLARKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE ELIZABETH DAIGLE

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 KIRBY DR SUITE M
HOUSTON TX
77005-2449
US

IV. Provider business mailing address

5600 KIRBY DR SUITE M
HOUSTON TX
77005-2449
US

V. Phone/Fax

Practice location:
  • Phone: 281-741-5910
  • Fax: 713-583-1113
Mailing address:
  • Phone: 281-741-5910
  • Fax: 713-583-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberQ5375
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: