Provider Demographics
NPI:1851484489
Name:SHURTLIFF, MAX H (CRNA)
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:H
Last Name:SHURTLIFF
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 W 6000 S
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067
Mailing Address - Country:US
Mailing Address - Phone:801-993-9527
Mailing Address - Fax:
Practice Address - Street 1:3580 W 9000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84070
Practice Address - Country:US
Practice Address - Phone:801-993-9527
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT212191-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT102600OtherGEM
UT293654OtherDMBA
UT39005OtherPEHP
UT870542403 84121 A003OtherTRICARE
UTPR00993OtherMOLINA
UTQMXAF01875OtherALTIUS
UT107001189102OtherIHC
UT870542403SH1OtherEDUCATORS MUTUAL
UTQMXAF01875OtherALTIUS