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 1:3820 NORTHDALE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1893
Mailing Address - Country:US
Mailing Address - Phone:800-991-6117
Mailing Address - Fax:
Practice Address - Street 1:3665 JOHN F KENNEDY PKWY
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3152
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDR.0004169202K00000X, 208600000X
AZ27566208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ770002185OtherRAIL ROAD MEDICARE
AZ1Z4750OtherHEALTH NET
AZ473512Medicaid
AZ770002185OtherEVERCARE PROVIDER NUMBER
AZAZ0847420OtherBLUE CROSS BLUE SHIELD
AZ27244Medicare ID - Type Unspecified
AZ770002185OtherRAIL ROAD MEDICARE