Individual
MR. GREGG IAN SHORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4759 LAKEVIEW DR, STE 101, SEBRING, FL 33870-2005
(863) 402-5600
(863) 402-5602
Mailing address
4759 LAKEVIEW DR, STE 101, SEBRING, FL 33870-2005
(863) 402-5600
(863) 402-5602
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
ME91364
FL
208C00000X
Colon & Rectal Surgery Physician
0436711
KS
208C00000X
Colon & Rectal Surgery Physician
Primary
ME91364
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
279783600
—
FL
05
—
3710089
—
TN
01
—
P00603445
MEDICARE RAILROAD PROVIDER NUMBER
FL
Enumeration date
07/15/2005
Last updated
04/09/2017
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