Provider Demographics
NPI:1609856749
Name:ENGLAND, JACK D (DO)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:D
Last Name:ENGLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S WILCOX STREET
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-2662
Mailing Address - Country:US
Mailing Address - Phone:303-688-6900
Mailing Address - Fax:303-688-1417
Practice Address - Street 1:410 S WILCOX STREET
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2662
Practice Address - Country:US
Practice Address - Phone:303-688-6900
Practice Address - Fax:303-688-1417
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16446207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01164466Medicaid
CO04007407Medicaid
CO04007407Medicaid
COC64244Medicare PIN