Organization
EAR NOSE & THROAT SPECIALISTS OF ROCKFORD SC
Active
Other names
James Melvin Severson
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES MELVIN SEVERSON III MD (MEDICAL DOCTOR)
(815) 399-5268
Entity
Organization
Contact information
Practice address
435 N MULFORD RD, SUITE 10, ROCKFORD, IL 61107-5189
(815) 399-5268
(815) 399-3623
Mailing address
435 N MULFORD RD, SUITE 10, ROCKFORD, IL 61107-5189
(815) 399-5268
(815) 399-3623
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
036067207
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036067207
—
IL
Enumeration date
05/24/2007
Last updated
03/27/2012
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