Provider Demographics
NPI:1710305396
Name:ERASO, KATHRYN MINCE (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:MINCE
Last Name:ERASO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:MINCE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-633-0880
Mailing Address - Fax:904-633-0881
Practice Address - Street 1:1887 KINGSLEY AVE STE 1500
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4481
Practice Address - Country:US
Practice Address - Phone:904-633-0880
Practice Address - Fax:904-633-0881
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME135926207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program