Individual
JASON OWEN ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.S.
Contact information
Practice address
9500 EUCLID AVENUE, CRILE BUILDING, 12TH FLOOR, CLEVELAND, OH 44195
(216) 445-4051
Mailing address
9500 EUCLID AVENUE, CRILE BUILDING, 12TH FLOOR, CLEVELAND, OH 44195
(216) 445-4051
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2009013686
MO
2086S0120X
Pediatric Surgery Physician
Primary
35136881
OH
390200000X
Student in an Organized Health Care Education/Training Program
4301109273
MI
390200000X
Student in an Organized Health Care Education/Training Program
ME131871
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2009013686
MISSOURI TEMPORARY LICENSE
MO
Enumeration date
06/20/2009
Last updated
07/11/2019
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