Provider Demographics
NPI:1396994745
Name:VOS, JESSE W (PA)
Entity type:Individual
Prefix:
First Name:JESSE
Middle Name:W
Last Name:VOS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 S RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-6821
Mailing Address - Country:US
Mailing Address - Phone:707-464-8335
Mailing Address - Fax:707-464-8339
Practice Address - Street 1:1575 S RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-6821
Practice Address - Country:US
Practice Address - Phone:707-464-8335
Practice Address - Fax:707-464-8339
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19884363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083953OtherNCCPA LIC NUMBER
CAPA19884OtherPA LIC NUMBER