Healthcare Provider Details

I. General information

NPI: 1760664940
Provider Name (Legal Business Name): JAIRO A ERASO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAIRO A ERASO ZAMORA M.D.

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 01/02/2024
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

PO BOX 71807
HENRICO VA
23255-1807
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6000
  • Fax: 414-385-8032
Mailing address:
  • Phone: 877-794-2284
  • Fax: 804-612-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50877-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number50877-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: