Provider Demographics
NPI:1487760534
Name:ROLLINS, JASON L (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:L
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 PRINCETON AVE SW
Mailing Address - Street 2:STE 115
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211
Mailing Address - Country:US
Mailing Address - Phone:205-780-1963
Mailing Address - Fax:205-780-2345
Practice Address - Street 1:817 PRINCETON AVE SW
Practice Address - Street 2:STE 115
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211
Practice Address - Country:US
Practice Address - Phone:205-780-1963
Practice Address - Fax:205-780-2345
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25072207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51542067OtherBLUE CROSS
ALZ08561OtherVIVA HEALTH
ALD497Medicare PIN