Healthcare Provider Details

I. General information

NPI: 1669471538
Provider Name (Legal Business Name): JACK W TUBBS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8580 SCARBOROUGH DR SUITE 100
COLORADO SPRINGS CO
80920-7583
US

IV. Provider business mailing address

8580 SCARBOROUGH DR STE 100
COLORADO SPRINGS CO
80920-7583
US

V. Phone/Fax

Practice location:
  • Phone: 719-596-3344
  • Fax: 719-632-6118
Mailing address:
  • Phone: 719-596-3344
  • Fax: 719-632-6118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number17891
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number28714
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number28714
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: