Individual
JASON ROBERTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, ATC
Contact information
Practice address
1420 N MONROE ST, MONROE, MI 48162-4211
(734) 240-8480
Mailing address
1 SEAGATE STE 800, TOLEDO, OH 43604-1558
(734) 240-8480
(734) 384-0469
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5315089057
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215446158
—
MI
Enumeration date
09/22/2017
Last updated
11/03/2023
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