Provider Demographics
NPI:1639286669
Name:FURST, SHELDON R (MD)
Entity Type:Individual
Prefix:
First Name:SHELDON
Middle Name:R
Last Name:FURST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MARIO CAPECCHI DR
Mailing Address - Street 2:PCMC DEPARTMENT OF ANESTHESIA
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84113-1103
Mailing Address - Country:US
Mailing Address - Phone:801-662-3578
Mailing Address - Fax:
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:PCMC DEPARTMENT OF ANESTHESIA
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-3578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT272211-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002966700Medicaid
UTQM0000049513OtherALTIUS
WY109784900Medicaid
UT2805OtherHEALTHY U
UTPR01081OtherMOLINA
UT002085744OtherFIRST HEALTH
UT32752OtherPEHP
UT416933OtherDESERET MUTUAL
UT107007177101OtherIHC
UT2000040OtherUNITED
MT401765Medicaid
UT870280408FU1OtherEDUCATORS MUTUAL
AZ937055Medicaid
UT870280408FU1OtherEDUCATORS MUTUAL
UT107007177101OtherIHC