Healthcare Provider Details

I. General information

NPI: 1952354276
Provider Name (Legal Business Name): WALTER SEVERYN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST MEMORIAL REGIONAL HOSPITAL - DEPT. OF CRITICAL CARE
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

3501 JOHNSON ST MEMORIAL REGIONAL HOSPITAL - DEPT. OF CRITICAL CARE
HOLLYWOOD FL
33021-5421
US

V. Phone/Fax

Practice location:
  • Phone: 954-987-2020
  • Fax: 954-965-5396
Mailing address:
  • Phone: 954-987-2020
  • Fax: 954-965-5396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME33035
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME33035
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: