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General NPI Number Information
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NPI Number | 1245883537
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Entity Type | Organization
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Legal Business Name | CAROLINE CLARKE MD PLLC
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Dates
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Enumeration Date | 07/16/2019
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 800 PEAKWOOD DR STE 8B
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City | HOUSTON
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State | TX
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Zip | 77090-2904
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Country | US
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Telephone | 346-202-4660
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Fax |
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Provider Business Mailing Address
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Address Line | 7 BOWERBANK CT
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City | MAGNOLIA
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State | TX
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Zip | 77354-3281
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KENT OLSAN
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Credential |
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Telephone | 281-467-4047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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