Organization
JTBL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TREVOR FERGUSON (OWNER)
(480) 331-1745
Entity
Organization
Contact information
Practice address
3303 E BASELINE RD, GILBERT, AZ 85234-2738
(480) 331-1745
Mailing address
2487 S GILBERT RD STE 106-133, GILBERT, AZ 85295-2805
(480) 331-1745
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
04/25/2019
Last updated
04/25/2019
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