Provider Demographics
NPI:1740257658
Name:SEVERANCE, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:SEVERANCE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4100 E MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-3048
Mailing Address - Country:US
Mailing Address - Phone:303-552-9522
Mailing Address - Fax:720-729-7668
Practice Address - Street 1:4100 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-3048
Practice Address - Country:US
Practice Address - Phone:303-552-9522
Practice Address - Fax:720-729-7668
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2016-03-08
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Provider Licenses
StateLicense IDTaxonomies
WI36578-020207Q00000X
CODR.0051889207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIG61789Medicare UPIN