Shore, Gregg Ian

Shore, Gregg Ian is an individual health care provider with primary practice located at 4759 Lakeview Dr Ste 101, Sebring FL 33870-2005. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Colon & Rectal Surgery, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Colon & Rectal Surgery is his primary health care specialty. Shore, Gregg Ian can be contacted via phone (863) 402-5600.

Contact Information

Primary practice address
4759 Lakeview Dr Ste 101 Sebring FL 33870-2005
Phone: (863) 402-5600
Fax: (863) 402-5602
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X ME91364 Florida
Allopathic & Osteopathic Physicians / Surgery 208600000X ME91364 Florida
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X 0436711 Kansas

Profile Details

NPI number 1235138983
LBN Legal business name Shore, Gregg Ian
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 15th, 2005
Last updated Apr 9th, 2017 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235138983 NPPES
Tennessee MEDICAID 3710089
Tennessee Other P00603445
Tennessee MEDICAID 279783600

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