Provider Demographics
NPI:1760664940
Name:ERASO, JAIRO A (MD)
Entity Type:Individual
Prefix:
First Name:JAIRO
Middle Name:A
Last Name:ERASO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAIRO
Other - Middle Name:A
Other - Last Name:ERASO ZAMORA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 71807
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23255-1807
Mailing Address - Country:US
Mailing Address - Phone:877-794-2284
Mailing Address - Fax:804-612-5201
Practice Address - Street 1:2900 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4330
Practice Address - Country:US
Practice Address - Phone:414-649-6000
Practice Address - Fax:414-385-8032
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50877-20207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34985900Medicaid
WI34985900Medicaid
WI34985900Medicaid