Provider Demographics
NPI:1508801895
Name:SEVILLA-MOYA, PASCUAL (MD)
Entity Type:Individual
Prefix:DR
First Name:PASCUAL
Middle Name:
Last Name:SEVILLA-MOYA
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:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:MI
Mailing Address - Zip Code:49327-0007
Mailing Address - Country:US
Mailing Address - Phone:231-834-0444
Mailing Address - Fax:231-834-0200
Practice Address - Street 1:11 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:MI
Practice Address - Zip Code:49327-7900
Practice Address - Country:US
Practice Address - Phone:231-834-0444
Practice Address - Fax:231-834-0200
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2016-02-11
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-02-28
Provider Licenses
StateLicense IDTaxonomies
MI43010173174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8916OtherMEDICAL LICENSE
PR8916OtherMEDICAL LICENSE
MIMI2051011Medicare PIN