Provider Demographics
NPI:1568492346
Name:TWINING, JON MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:MITCHELL
Last Name:TWINING
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 1:8220 NIGELS DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4125
Mailing Address - Country:US
Mailing Address - Phone:843-692-0968
Mailing Address - Fax:843-692-2688
Practice Address - Street 1:8220 NIGELS DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4125
Practice Address - Country:US
Practice Address - Phone:843-692-0968
Practice Address - Fax:843-692-2688
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27712207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA15026954OtherMEDICARE NUMBER
SCI58725Medicare UPIN