Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 MIDNIGHT PASS RD SUITE 4
SARASOTA FL
34242-3083
US

IV. Provider business mailing address

5700 MIDNIGHT PASS RD SUITE 4
SARASOTA FL
34242-3083
US

V. Phone/Fax

Practice location:
  • Phone: 561-400-9900
  • Fax: 561-208-8386
Mailing address:
  • Phone: 561-400-9900
  • Fax: 561-208-8386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME82169
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME82169
License Number StateFL

VIII. Authorized Official

Name: CARL R NOBACK
Title or Position: PRESIDENT
Credential: MD
Phone: 561-400-9900