Healthcare Provider Details

I. General information

NPI: 1174548226
Provider Name (Legal Business Name): MARK PARIS MD MPH DTM&H AAHIVS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E LINTON BLVD SUITE 203A
DELRAY BEACH FL
33483-3327
US

IV. Provider business mailing address

7499 SAN CLEMENTE PL
BOCA RATON FL
33433-1005
US

V. Phone/Fax

Practice location:
  • Phone: 561-265-4969
  • Fax: 561-265-4392
Mailing address:
  • Phone: 305-318-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0001X
TaxonomyClinical & Laboratory Immunology (Internal Medicine) Physician
License NumberME79610
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME79610
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME79610
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME79610
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: