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:
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Health care specialties

SpecialtyCodeLicense #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 5 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.

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Identifiers

StateTypeNumberIssuer
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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