Provider Demographics
NPI:1477182756
Name:JASSO, ERIKA YISSEL (MD)
Entity type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:YISSEL
Last Name:JASSO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1717 S RANGE LINE RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3234
Mailing Address - Country:US
Mailing Address - Phone:417-556-2041
Mailing Address - Fax:
Practice Address - Street 1:1717 S RANGE LINE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3234
Practice Address - Country:US
Practice Address - Phone:417-556-2040
Practice Address - Fax:417-556-2041
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE16728207R00000X
MO2023029950207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine