MEDICARE: MR. DAN G. SEVERA 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	207Q00000X	Family Medicine Physician	0425270	KS
2	207Q00000X	Family Medicine Physician	S6935	TX

General Provider Information

NPI Number	:	1750319323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAN G. SEVERA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	254-724-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 HALEY RD
Second Line	:
City	:	JOHNSON CITY
State	:	TX
Zip	:	78636-4617
Country	:	US
Telephone Number	:	830-868-9500
Fax Number	:	830-868-4606

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2025

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