Healthcare Provider Details

I. General information

NPI: 1972783025
Provider Name (Legal Business Name): JABEZ-BLOCHER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 S POWER RD #120
GILBERT AZ
85297-9281
US

IV. Provider business mailing address

8490 S POWER RD #105-244
GILBERT AZ
85297-8028
US

V. Phone/Fax

Practice location:
  • Phone: 480-200-3016
  • Fax:
Mailing address:
  • Phone: 480-200-3016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0359
License Number StateAZ

VIII. Authorized Official

Name: KENNETH SHERMAN BLOCHER
Title or Position: CEO
Credential: DPM
Phone: 480-200-3016