Provider Demographics
NPI:1669427183
Name:SEVILLA, MILTON JESUS (MD, FAAP)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:JESUS
Last Name:SEVILLA
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Gender:M
Credentials:MD, FAAP
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Mailing Address - Street 1:14341 NEW FALLS OF NEUSE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-8292
Mailing Address - Country:US
Mailing Address - Phone:919-570-7010
Mailing Address - Fax:919-570-7020
Practice Address - Street 1:14341 NEW FALLS OF NEUSE RD.
Practice Address - Street 2:SUITE 122
Practice Address - City:RA;EIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8292
Practice Address - Country:US
Practice Address - Phone:919-570-7010
Practice Address - Fax:919-570-7020
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89130T6Medicaid
NC89130T6Medicaid