Individual
JACQUELYN R. ROBERSON
Active
Individual
JACQUELYN R. ROBERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
4301037509
MI
208000000X
Pediatrics Physician
4301037509
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134265610
—
MI
01
—
700H262280
BLUE CROSS-BLUE CROSS
—
01
—
JR037509
CHAMPUS-CHAMPUS
—
Enumeration date
11/29/2006
Last updated
03/01/2021
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