Healthcare Provider Details

I. General information

NPI: 1821625732
Provider Name (Legal Business Name): PETER C NOBACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 10/05/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 S. MAIN STRTEET
WALNUT CREEK CA
94596
US

IV. Provider business mailing address

622 W 168TH ST PH 11
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 925-295-6000
  • Fax:
Mailing address:
  • Phone: 212-305-5976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberA210495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: