Provider Demographics
NPI:1982687596
Name:JACOB, ROJYMON
Entity Type:Individual
Prefix:
First Name:ROJYMON
Middle Name:
Last Name:JACOB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL383762085R0001X
ALL2819SP2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051537246OtherBCBS
AL051537247OtherBCBS
AL009941293Medicaid
AL009941297Medicaid
AL009941298Medicaid
AL051537245OtherBCBS
AL051537243OtherBCBS
P00427467OtherRAILROAD MEDICARE
AL009941294Medicaid
AL009941296Medicaid
AL051537244OtherBCBS
AL051537248OtherBCBS
AL009941574Medicaid
AL051537245OtherBCBS
AL051537247OtherBCBS