Individual
DR. JACK HOLLAND MOODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
805 SIR THOMAS CT, FIRST FLOOR, HARRISBURG, PA 17109
(717) 988-0020
(717) 703-5746
Mailing address
805 SIR THOMAS CT FL 1, HARRISBURG, PA 17109-4839
(717) 988-0020
(717) 703-5746
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD040716L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001157470
—
PA
Enumeration date
05/05/2006
Last updated
01/26/2021
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