MEDICARE: DR. RANDALL JAMES SEVERANCE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	19969	AZ

General Provider Information

NPI Number	:	1558580399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL JAMES SEVERANCE M.D.

Provider Business Mailing Address
First Line	:	960 E VERMONT DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-1124
Country	:	US
Telephone Number	:	480-329-6857
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 E VERMONT DR
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-1124
Country	:	US
Telephone Number	:	480-329-6857
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	03/11/2026

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