Provider Demographics
NPI:1518962661
Name:PARAISO, JAMES JUDE (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JUDE
Last Name:PARAISO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848640
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-0640
Mailing Address - Country:US
Mailing Address - Phone:352-873-7770
Mailing Address - Fax:
Practice Address - Street 1:2102 SW 20TH PL STE 101
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0861
Practice Address - Country:US
Practice Address - Phone:352-873-7770
Practice Address - Fax:352-873-7704
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 9151174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269596100Medicaid
FLI11095Medicare UPIN
FL6136100001Medicare NSC
FL37996WMedicare PIN