Provider Demographics
NPI:1427417955
Name:ROBERGE, JEROME JR
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:
Last Name:ROBERGE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W CALLE PLATINO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2778
Mailing Address - Country:US
Mailing Address - Phone:520-273-2588
Mailing Address - Fax:
Practice Address - Street 1:204 W GRANT RD UNIT 110
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-5507
Practice Address - Country:US
Practice Address - Phone:520-273-2588
Practice Address - Fax:480-436-5339
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0864171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist