Provider Demographics
NPI:1235023045
Name:VONDEBUR, JACOB MATTHEW (PA-C)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:MATTHEW
Last Name:VONDEBUR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5009
Mailing Address - Country:US
Mailing Address - Phone:217-303-4991
Mailing Address - Fax:
Practice Address - Street 1:2303 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5009
Practice Address - Country:US
Practice Address - Phone:217-303-4991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program