Provider Demographics
NPI:1629503271
Name:JACOBS, ADAM PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:PATRICK
Last Name:JACOBS
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 1:619 19TH ST S # 338
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35249-6830
Mailing Address - Country:US
Mailing Address - Phone:205-934-3166
Mailing Address - Fax:205-975-4413
Practice Address - Street 1:619 19TH ST S # JTN338
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249
Practice Address - Country:US
Practice Address - Phone:205-934-3166
Practice Address - Fax:205-975-4413
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL378702085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program