Provider Demographics
NPI:1841275294
Name:SEVERSON, PAUL ANDREW (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANDREW
Last Name:SEVERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:320 E MAIN ST
Mailing Address - Street 2:CUYUNA REGIONAL MEDICAL CENTER
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441-1645
Mailing Address - Country:US
Mailing Address - Phone:218-546-7000
Mailing Address - Fax:218-545-4456
Practice Address - Street 1:320 E MAIN ST
Practice Address - Street 2:CUYUNA REGIONAL MEDICAL CENTER
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441-1645
Practice Address - Country:US
Practice Address - Phone:218-546-7000
Practice Address - Fax:218-545-4456
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN25093208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN577873500Medicaid
D48959Medicare UPIN
MN577873500Medicaid