Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G63482 | CA |
N | 207XS0106X | Orthopaedic Hand Surgeon | G63482 | CA |
NPI | 1003854159 |
---|---|
Provider Name | Raymond Severt |
First Address | Santa Rosa, CA 95405-4812 |
Second Address | Santa Rosa, CA 95405-4812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 07/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G634820 | (05) | CA |
1003854159 | (02) | CA |
1003854159 | MD CONDEREN MEDICAL BILLING (01) | CA |
F28991 | (02) | CA |