Healthcare Provider Details

I. General information

NPI: 1265759450
Provider Name (Legal Business Name): AMY MYERS CAJACOB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S
BIRMINGHAM AL
35249-1900
US

IV. Provider business mailing address

703 VOLKER HALL
BIRMINGHAM AL
35294-0001
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-9666
  • Fax:
Mailing address:
  • Phone: 205-934-3795
  • Fax: 205-975-8991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD.31451
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: