Provider Demographics
NPI:1699833509
Name:ROOK, JACK L (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:L
Last Name:ROOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 W COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-1517
Mailing Address - Country:US
Mailing Address - Phone:719-227-0101
Mailing Address - Fax:719-227-0303
Practice Address - Street 1:923 W COLORADO AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-1517
Practice Address - Country:US
Practice Address - Phone:719-227-0101
Practice Address - Fax:719-227-0303
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO301282081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01-301282Medicaid
COC77721OtherMEDICARE P-TAN
CO01-301282Medicaid