=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427417955
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEROME ROBERGE JR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2016
-----------------------------------------------------
Last Update Date | 08/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 W GRANT RD UNIT 110
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85705-5507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-273-2588
-----------------------------------------------------
Fax | 480-436-5339
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1414 W CALLE PLATINO
-----------------------------------------------------
City | TUCSON
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85745-2778
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 520-273-2588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 0864
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------