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General NPI Number Information
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NPI Number | 1790280121
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Entity Type | Individual
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Provider Name | MATTHEW BARTON DEAN SHIRLEY MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 900 ROUND VALLEY DR STE 100
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City | PARK CITY
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State | UT
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Zip | 84060-7552
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Country | US
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Telephone | 435-655-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 900 ROUND VALLEY DR STE 100
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City | PARK CITY
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State | UT
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Zip | 84060-7552
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 2023-01418
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License Number State | NC
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