Individual
MUSA MODAD
Active
Individual
MUSA MODAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
103780
MO
207R00000X
Internal Medicine Physician
103780
MO
207R00000X
Internal Medicine Physician
Primary
M-12814
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1235680703
NPI # FOR INTERNAL MEDICINE CLINIC
ID
05
—
1902917834
—
MO
05
—
206687410
—
MO
01
—
M-12814
IDAHO LICENSE
ID
01
—
P00430675
RAILROAD MEDICARE
—
Enumeration date
08/31/2006
Last updated
07/21/2022
Update your record
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