Provider Demographics
NPI:1730132556
Name:JACOB, MINA AYAD (MD,FACC,FSCAI)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:AYAD
Last Name:JACOB
Suffix:
Gender:M
Credentials:MD,FACC,FSCAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 SPRING HILL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-1416
Mailing Address - Country:US
Mailing Address - Phone:251-435-1200
Mailing Address - Fax:251-435-6357
Practice Address - Street 1:1700 SPRING HILL AVE STE 100
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-1416
Practice Address - Country:US
Practice Address - Phone:251-435-1200
Practice Address - Fax:251-435-6357
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31294207RA0002X, 207RC0000X, 207RI0011X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000946844PMedicaid
GA000946844XMedicaid
GA000946844Medicaid
GA000946844KMedicaid
GA000946844LMedicaid
GA000946844QMedicaid
GA000946844RMedicaid
GA00946844AMedicaid
GA000946844OMedicaid
AL167695Medicaid
GA202I068779Medicare PIN
GAG83954Medicare UPIN
GA000946844OMedicaid
GA000946844KMedicaid
GA202I062778Medicare PIN