Roberson, Jacquelyn R.
Roberson, Jacquelyn R. is an individual health care provider with primary practice located at Henry Ford Health System 2799 West Grand Boulevard, Detroit MI 48202. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.). Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.) is her primary health care specialty. Roberson, Jacquelyn R. can be contacted via phone (313) 916-2436.Contact Information
Primary practice address
Henry Ford Health System 2799 West Grand Boulevard
Detroit MI 48202
Phone: (313) 916-2436
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 4301037509 | Michigan |
| Allopathic & Osteopathic Physicians / Clinical Genetics (M.D.) | 207SG0201X | 4301037509 | Michigan |
Profile Details
| NPI number | 1982771358 |
|---|---|
| LBN Legal business name | Roberson, Jacquelyn R. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 29th, 2006 |
| Last updated | Mar 1st, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1982771358 | NPPES |
| Other | JR037509 | CHAMPUS-CHAMPUS | |
| Other | JR037509 | CHAMPUS-CHAMPUS | |
| MEDICAID | 134265610 | CHAMPUS-CHAMPUS | |
| Other | 700H262280 | CHAMPUS-CHAMPUS |
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