Provider Demographics
NPI:1134110430
Name:PARIS, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
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 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3516
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7980 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4170
Practice Address - Country:US
Practice Address - Phone:260-478-5280
Practice Address - Fax:260-458-3536
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039725A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100318120Medicaid
000000091885OtherBLUE CROSS BLUE SHIELD
IN080121953OtherRAILROAD MEDICARE
000000000832OtherMPLAN
1672OtherPHYSICIANS HEALTH PLAN
E52689Medicare UPIN
INM400048166Medicare PIN
000000091885OtherBLUE CROSS BLUE SHIELD
1672OtherPHYSICIANS HEALTH PLAN