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General NPI Number Information
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NPI Number | 1699833509
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Entity Type | Individual
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Provider Name | JACK L ROOK M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 923 W COLORADO AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80905-1517
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Country | US
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Telephone | 719-227-0101
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Fax | 719-227-0303
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Provider Business Mailing Address
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Address Line | 923 W COLORADO AVE
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City | COLORADO SPRINGS
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State | CO
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Zip | 80905-1517
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Country | US
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Telephone | 719-227-0101
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Fax | 719-227-0303
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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 | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 30128
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License Number State | CO
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