Provider Demographics
NPI:1669634242
Name:SEVILLA, RAMON M (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:M
Last Name:SEVILLA
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 580
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45802-0580
Mailing Address - Country:US
Mailing Address - Phone:419-224-5707
Mailing Address - Fax:419-223-2726
Practice Address - Street 1:1900 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1214
Practice Address - Country:US
Practice Address - Phone:419-423-5429
Practice Address - Fax:419-423-5297
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1244332085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0110602Medicaid
OH0110602Medicaid