Provider Demographics
NPI:1124710280
Name:SHURTLIFF, ADAM GARY (DPM)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:GARY
Last Name:SHURTLIFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9304 SNOW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-2125
Mailing Address - Country:US
Mailing Address - Phone:801-717-7279
Mailing Address - Fax:
Practice Address - Street 1:9304 SNOW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-2125
Practice Address - Country:US
Practice Address - Phone:801-717-7279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program