Healthcare Provider Details

I. General information

NPI: 1043625080
Provider Name (Legal Business Name): MERWIN SEVERTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2014
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRIT AVE STOP A
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

2817 ROCK MERRIT AVE STOP A
FORT BRAGG NC
28310-0001
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number6906
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2018-00507
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: