Basic Information
| Provider Information | |||||||||
| NPI: | 1982637948 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEVILLE | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | ZAMORA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6401 KIMBALL DRIVE, NW | ||||||||
| Address2: | STE 202 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538589192 | ||||||||
| FaxNumber: | 2538584330 | ||||||||
| Practice Location | |||||||||
| Address1: | 6401 KIMBALL DRIVE, NW | ||||||||
| Address2: | STE 202 | ||||||||
| City: | GIG HARBOR | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538589192 | ||||||||
| FaxNumber: | 2538584330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 04/15/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A78182 | CA | N | Other Service Providers | Specialist | 208800000X | MD00048744 | WA | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 00A78120 | 05 | CA | MEDICAID | 8945364 | 01 | WA | STATE CRIME VICTIMS | OTHER | P00467951 | 01 | WA | MEDICARE RAILROAD | OTHER | 8945364 | 05 | WA | MEDICAID | 0225685 | 01 | WA | STATE L&I | OTHER | 0224050 | 01 | WA | STATE L&I | OTHER | 0224051 | 01 | WA | STATE L&I | OTHER | 0224716 | 01 | WA | STATE L&I | OTHER | 0226773 | 01 | WA | STATE L&I | OTHER |