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Individual
GREGORY SCOTT MASIMORE
Active
Individual
GREGORY SCOTT MASIMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
01042621A
IN
208VP0014X
Interventional Pain Medicine Physician
01042621A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000476069
SIA ANTHEM
IN
05
—
200816430
—
IN
Enumeration date
05/17/2006
Last updated
12/13/2017
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