Provider Demographics
NPI:1760747968
Name:CLARK, ELIZABETH LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LOUISE
Last Name:CLARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23845 HOLMAN HWY STE 227
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5901
Mailing Address - Country:US
Mailing Address - Phone:831-624-3579
Mailing Address - Fax:831-886-3611
Practice Address - Street 1:23845 HOLMAN HWY STE 227
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5901
Practice Address - Country:US
Practice Address - Phone:831-624-3579
Practice Address - Fax:831-886-3611
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ8038207V00000X
CA157782207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology