Healthcare Provider Details

I. General information

NPI: 1346568664
Provider Name (Legal Business Name): NICHOLAS JEREMY CAJACOB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE SOUTH MCWANE 5604
BIRMINGHAM AL
35249-1900
US

IV. Provider business mailing address

1600 7TH AVE SOUTH MCWANE 5604
BIRMINGHAM AL
35249-1900
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-9918
  • Fax:
Mailing address:
  • Phone: 205-638-9918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.31444
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberMD.31444
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: