Provider Demographics
NPI:1982637948
Name:SEVILLE, PAUL ZAMORA (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ZAMORA
Last Name:SEVILLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6401 KIMBALL DRIVE, NW
Mailing Address - Street 2:STE 202
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-858-9192
Mailing Address - Fax:253-858-4330
Practice Address - Street 1:6401 KIMBALL DRIVE, NW
Practice Address - Street 2:STE 202
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-858-9192
Practice Address - Fax:253-858-4330
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78182174400000X
WAMD00048744208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A78120Medicaid
WA8945364OtherSTATE CRIME VICTIMS
WAP00467951OtherMEDICARE RAILROAD
WA8945364Medicaid
WA0225685OtherSTATE L&I
WA0224050OtherSTATE L&I
WA0224051OtherSTATE L&I
WA0224716OtherSTATE L&I
WA0226773OtherSTATE L&I
WAG8868021Medicare PIN
WAG8867390Medicare PIN
WA0224716OtherSTATE L&I
CAH56247Medicare UPIN
WAG8867391Medicare PIN