Healthcare Provider Details

I. General information

NPI: 1164888061
Provider Name (Legal Business Name): CLAYTON SHURTLIFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 CHAMPIONS PLAZA DR SUITE 400
HOUSTON TX
77069-2396
US

IV. Provider business mailing address

7010 CHAMPIONS PLAZA DR SUITE 400
HOUSTON TX
77069-2396
US

V. Phone/Fax

Practice location:
  • Phone: 281-880-9180
  • Fax: 832-698-5171
Mailing address:
  • Phone: 281-880-9180
  • Fax: 832-698-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number809435
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: