Individual
JUDSON MALCOME SEVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
900 SCOTT AND WHITE DR, COLLEGE STATION, TX 77845-6419
(979) 207-7400
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
(254) 724-8800
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
M3384
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
198296903
—
TX
05
—
198296904
—
TX
05
—
198296905
—
TX
05
—
198296908
—
TX
01
—
8DE548
BC/BS#
TX
01
—
P00799975
RAILROAD MEDICARE #
TX
Enumeration date
07/02/2007
Last updated
07/23/2025
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