Provider Demographics
NPI:1174548226
Name:PARIS, MARK (MD MPH DTM&H AAHIVS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:PARIS
Suffix:
Gender:M
Credentials:MD MPH DTM&H AAHIVS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7499 SAN CLEMENTE PL
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1005
Mailing Address - Country:US
Mailing Address - Phone:305-318-7585
Mailing Address - Fax:
Practice Address - Street 1:100 E LINTON BLVD
Practice Address - Street 2:SUITE 203A
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-3327
Practice Address - Country:US
Practice Address - Phone:561-265-4969
Practice Address - Fax:561-265-4392
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79610207RI0001X, 207W00000X, 2083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory Immunology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2623277-00Medicaid
FL2623277-00Medicaid