Provider Demographics
NPI:1114028040
Name:PARIS, MARC D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:PARIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 UNIVERSITY AVENUE
Mailing Address - Street 2:HEALDSBURG DISTRICT HOSPITAL
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448
Mailing Address - Country:US
Mailing Address - Phone:707-431-6500
Mailing Address - Fax:
Practice Address - Street 1:1375 UNIVERSITY AVENUE
Practice Address - Street 2:HEALDSBURG DISTRICT HOSPITAL
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448
Practice Address - Country:US
Practice Address - Phone:707-431-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36070207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C360700Medicaid
CA00C360700Medicaid
CA00C360700Medicare ID - Type Unspecified