Provider Demographics
NPI:1952306847
Name:SEVER, CHARLES ALLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALLEN
Last Name:SEVER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-8727
Mailing Address - Country:US
Mailing Address - Phone:405-282-6700
Mailing Address - Fax:405-282-4826
Practice Address - Street 1:200 S ACADEMY RD
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044
Practice Address - Country:US
Practice Address - Phone:405-282-6700
Practice Address - Fax:405-282-4826
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07352363A00000X
WI1702363AM0700X
OK2912363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41985000Medicaid
WIP00623891OtherRAIL ROAD MEDICARE
WI41985000Medicaid
WIP00623891OtherRAIL ROAD MEDICARE
WI0126 00507Medicare PIN
TXTXB143524Medicare PIN
TXTXB143525Medicare PIN