Individual
MAX H SHURTLIFF
Active
Individual
MAX H SHURTLIFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
212191-4406
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102600
GEM
UT
01
—
107001189102
IHC
UT
01
—
293654
DMBA
UT
01
—
39005
PEHP
UT
01
—
870542403 84121 A003
TRICARE
UT
01
—
870542403SH1
EDUCATORS MUTUAL
UT
01
—
PR00993
MOLINA
UT
01
—
QMXAF01875
ALTIUS
UT
Enumeration date
10/02/2006
Last updated
07/08/2007
Update your record
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