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General NPI Number Information
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NPI Number | 1669471538
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Entity Type | Individual
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Provider Name | JACK W TUBBS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2005
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 8580 SCARBOROUGH DR SUITE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7583
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Country | US
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Telephone | 719-596-3344
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Fax | 719-632-6118
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Provider Business Mailing Address
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Address Line | 8580 SCARBOROUGH DR STE 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80920-7583
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Country | US
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Telephone | 719-596-3344
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Fax | 719-632-6118
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 17891
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 28714
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License Number State | CO
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 28714
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License Number State | CO
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