Provider Demographics
NPI:1114982618
Name:TWENA, MORDECHAI FERRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MORDECHAI
Middle Name:FERRIS
Last Name:TWENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5659 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2211
Mailing Address - Country:US
Mailing Address - Phone:520-731-3317
Mailing Address - Fax:520-731-1933
Practice Address - Street 1:5659 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2211
Practice Address - Country:US
Practice Address - Phone:520-731-3317
Practice Address - Fax:520-731-1933
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27566208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0847420OtherBLUE CROSS BLUE SHIELD
AZ1Z4750OtherHEALTH NET
AZ473512Medicaid
AZ770002185OtherRAIL ROAD MEDICARE
AZ770002185OtherEVERCARE PROVIDER NUMBER
AZ27244Medicare ID - Type Unspecified
AZ770002185OtherRAIL ROAD MEDICARE