Individual
ERNEST C SEVERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1756 W PARK AVE, RIVERTON, UT 84065-4701
(801) 254-0309
(801) 254-1012
Mailing address
1756 W PARK AVE, RIVERTON, UT 84065-4701
(801) 254-0309
(801) 254-1012
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8262575-1204
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168505902
—
TX
01
—
8S0440
BCBS
TX
Enumeration date
06/11/2006
Last updated
12/05/2020
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