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General NPI Number Information
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NPI Number | 1396994745
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Entity Type | Individual
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Provider Name | JESSE W VOS P.A.
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Gender | Male
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1575 S RAILROAD AVE
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City | CRESCENT CITY
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State | CA
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Zip | 95531-6821
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Country | US
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Telephone | 707-464-8335
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Fax | 707-464-8339
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Provider Business Mailing Address
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Address Line | 1575 S RAILROAD AVE
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City | CRESCENT CITY
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State | CA
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Zip | 95531-6821
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Country | US
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Telephone | 707-464-8335
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Fax | 707-464-8339
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA19884
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License Number State | CA
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