Provider Demographics
NPI:1437628104
Name:ROBERSON, JERRY (DRPH)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:M
Credentials:DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76004-0084
Mailing Address - Country:US
Mailing Address - Phone:817-822-4954
Mailing Address - Fax:
Practice Address - Street 1:18040 MIDWAY RD APT 135
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-6506
Practice Address - Country:US
Practice Address - Phone:817-822-4954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator