Healthcare Provider Details

I. General information

NPI: 1750365516
Provider Name (Legal Business Name): CHRISTOPHER CLARK SEVERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W LAS POSITAS BLVD
PLEASANTON CA
94588-4000
US

IV. Provider business mailing address

50 MARTHA RD
ORINDA CA
94563-3536
US

V. Phone/Fax

Practice location:
  • Phone: 209-342-2300
  • Fax: 209-524-4240
Mailing address:
  • Phone: 925-416-6585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA90347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: