Provider Demographics
NPI:1487933511
Name:GMORA, SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:GMORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 CHARLTON AVE EAST
Mailing Address - Street 2:G836
Mailing Address - City:HAMILTON
Mailing Address - State:ON
Mailing Address - Zip Code:L8N 4A6
Mailing Address - Country:CA
Mailing Address - Phone:905-522-1155
Mailing Address - Fax:905-308-7231
Practice Address - Street 1:50 CHARLTON AVE EAST
Practice Address - Street 2:G836
Practice Address - City:HAMILTON
Practice Address - State:ON
Practice Address - Zip Code:L8N 4A6
Practice Address - Country:CA
Practice Address - Phone:905-522-1155
Practice Address - Fax:905-308-7231
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-07
Last Update Date:2011-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ZZ95045208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery