Individual
MOMODU A JACK
Active
Individual
MOMODU A JACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
0101270422
VA
207RG0100X
Gastroenterology Physician
D0044035
MD
207RG0100X
Gastroenterology Physician
Primary
MD20286
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101267872
LICENSE
VA
05
—
018868500
—
DC
05
—
174961700
—
MD
Enumeration date
09/21/2006
Last updated
11/06/2020
Update your record
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