Provider Demographics
NPI:1427046259
Name:CLARKE, LIZABETH F (MD)
Entity type:Individual
Prefix:
First Name:LIZABETH
Middle Name:F
Last Name:CLARKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:109 RUE FOUNTAINE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5744
Mailing Address - Country:US
Mailing Address - Phone:337-266-9820
Mailing Address - Fax:337-266-9822
Practice Address - Street 1:426 CHARLES ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3707
Practice Address - Country:US
Practice Address - Phone:337-365-4156
Practice Address - Fax:337-365-4192
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA022577207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1490636Medicaid
H17409Medicare UPIN
LA1490636Medicaid