Individual
CLETUS TANWI MOMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4500 SAN PABLO RD S, PROVIDER ENROLLMENT, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Mailing address
4500 SAN PABLO RD S, PROVIDER ENROLLMENT, JACKSONVILLE, FL 32224-1865
(904) 953-2000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
TRN16006
FL
Other
Enumeration date
06/03/2011
Last updated
09/20/2011
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