Healthcare Provider Details

I. General information

NPI: 1124710280
Provider Name (Legal Business Name): ADAM GARY SHURTLIFF DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MEDICAL DR STE 230
BOUNTIFUL UT
84010-8932
US

IV. Provider business mailing address

PO BOX 849795
LOS ANGELES CA
90084-9795
US

V. Phone/Fax

Practice location:
  • Phone: 801-292-5070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number14267588-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: