MEDICARE: CARL R NOBACK ANESTHESIA & PAIN MANAGEMENT, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME82169	FL
2	207L00000X	Anesthesiology Physician	ME82169	FL

General Provider Information

NPI Number	:	1235435348
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARL R NOBACK ANESTHESIA & PAIN MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	5700 MIDNIGHT PASS RD
Second Line	:	SUITE 4
City	:	SARASOTA
State	:	FL
Zip	:	34242-3083
Country	:	US
Telephone Number	:	561-400-9900
Fax Number	:	561-208-8386

Provider Business Practice Location Address
First Line	:	5700 MIDNIGHT PASS RD
Second Line	:	SUITE 4
City	:	SARASOTA
State	:	FL
Zip	:	34242-3083
Country	:	US
Telephone Number	:	561-400-9900
Fax Number	:	561-208-8386

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARL R NOBACK
Credential	:	MD
Telephone Number	:	561-400-9900

Provider Enumeration Date	:	02/07/2011
Last Update Date	:	02/07/2011

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