Individual
JACK E COLKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
701 GROVE RD, ER ADMINISTRATION, GREENVILLE, SC 29605-5611
(864) 455-6372
Mailing address
255 ENTERPRISE BLVD, SUITE 250, GREENVILLE, SC 29615-6300
(864) 454-0888
(864) 454-1130
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
17721
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
177212
—
SC
01
—
57-6007863
BLUE CROSS
SC
01
—
930116693
RAILROAD
SC
Enumeration date
04/10/2006
Last updated
07/20/2007
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