Provider Demographics
NPI:1104078781
Name:CLARKE, CAROLINE ELIZABETH (MD)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:ELIZABETH
Other - Last Name:DAIGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5600 KIRBY DR
Mailing Address - Street 2:SUITE M
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2449
Mailing Address - Country:US
Mailing Address - Phone:281-741-5910
Mailing Address - Fax:713-583-1113
Practice Address - Street 1:5600 KIRBY DR
Practice Address - Street 2:SUITE M
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2449
Practice Address - Country:US
Practice Address - Phone:281-741-5910
Practice Address - Fax:713-583-1113
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5375208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery