Provider Demographics
NPI:1730079716
Name:JBM SURGICAL PLLC
Entity type:Organization
Organization Name:JBM SURGICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JORDEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-792-7647
Mailing Address - Street 1:1155 N REAY LN
Mailing Address - Street 2:
Mailing Address - City:THATCHER
Mailing Address - State:AZ
Mailing Address - Zip Code:85552-4301
Mailing Address - Country:US
Mailing Address - Phone:928-792-7647
Mailing Address - Fax:
Practice Address - Street 1:1155 N REAY LN
Practice Address - Street 2:
Practice Address - City:THATCHER
Practice Address - State:AZ
Practice Address - Zip Code:85552-4301
Practice Address - Country:US
Practice Address - Phone:928-792-7647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-09
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty