Healthcare Provider Details

I. General information

NPI: 1639286669
Provider Name (Legal Business Name): SHELDON R FURST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARIO CAPECCHI DR PCMC DEPARTMENT OF ANESTHESIA
SALT LAKE CITY UT
84113-1103
US

IV. Provider business mailing address

100 MARIO CAPECCHI DR PCMC DEPARTMENT OF ANESTHESIA
SALT LAKE CITY UT
84113-1103
US

V. Phone/Fax

Practice location:
  • Phone: 801-662-3578
  • Fax:
Mailing address:
  • Phone: 801-662-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number272211-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: