Provider Demographics
NPI:1952014334
Name:VOHSEN, JACOB WILLIAM (PA)
Entity type:Individual
Prefix:MR
First Name:JACOB
Middle Name:WILLIAM
Last Name:VOHSEN
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-9123
Mailing Address - Fax:314-747-9160
Practice Address - Street 1:2 PROGRESS POINT PKWY
Practice Address - Street 2:DEPT EMERGENCY MED
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2205
Practice Address - Country:US
Practice Address - Phone:314-362-9123
Practice Address - Fax:314-747-9160
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2025-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2024004740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant