Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 20A16577 | CA |
N | 208600000X | Surgeon | 20A16577 | CA |
Y | 208200000X | Surgeon | DO3054 | ME |
Y | 208600000X | Surgeon | DO3054 | ME |
N | 2086S0102X | Surgical Critical Care | DO3054 | ME |
N | 2086S0127X | Trauma Surgeon | 20A16577 | CA |
N | 2086S0127X | Trauma Surgeon | DO3054 | ME |
NPI | 1295173433 |
---|---|
Provider Name | Eric Matthew Shurtleff |
First Address | Portland, ME 04102-3166 |
Second Address | Portland, ME 04102-3175 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2013 |
Last Update Date | 17/08/2020 |