Individual
MR. GREGG IAN SHORE
Active
Individual
MR. GREGG IAN SHORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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