Individual
PERRY J SEVERANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 6TH AVE N, SAINT CLOUD, MN 56303-2735
(320) 252-5131
(320) 240-2118
Mailing address
1200 6TH AVE N, SAINT CLOUD, MN 56303-2735
(320) 262-5131
(320) 240-2118
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
25579
MN
207RI0200X
Infectious Disease Physician
Primary
25579
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
045098700
MEDICAL ASSISTANCE
—
01
—
1000006
PREFERRED ONE
—
01
—
108496
U-CARE
—
01
—
2114131
FIRST HEALTH PLAN
—
01
—
449000005
MEDICARE
—
01
—
600819
ARAZ GRP/AMERICA'S PPO
—
01
—
6D089SE
BLUE CROSS BLUE SHIELD
—
01
—
9227216
MEDICA HEALTH PLANS
—
01
—
HP22744
HEALTH PARTNERS
—
Enumeration date
10/17/2005
Last updated
12/13/2011
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