Individual
JACK M DREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 E BOULDER ST, COLORADO SPRINGS, CO 80909-5533
(719) 365-5853
(719) 365-1048
Mailing address
5901 TECHNOLOGY CENTER DR, INDIANAPOLIS, IN 46278-6013
(719) 578-1162
(719) 578-1462
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
DR.0051824
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24275069
—
CO
Enumeration date
10/24/2005
Last updated
10/05/2016
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