Healthcare Provider Details

I. General information

NPI: 1750370003
Provider Name (Legal Business Name): LORI D BOOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 01/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 MEDICAL CENTER PT
COLORADO SPRINGS CO
80907-8731
US

IV. Provider business mailing address

1625 MEDICAL CENTER PT
COLORADO SPRINGS CO
80907-8731
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-3276
  • Fax: 719-635-5804
Mailing address:
  • Phone: 719-630-3276
  • Fax: 719-635-5804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number42508
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: