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NPI Code Detail

MEDICARE: KEITH ALLAN NOBACK M.D.

MEDICARE: KEITH ALLAN NOBACK M.D.
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
1207Q00000XFamily Medicine Physician6371AWY
2207Q00000XFamily Medicine Physician51526AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154437317
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH ALLAN NOBACK M.D.
Provider Business Mailing Address
First Line : 3003 N CENTRAL AVE STE 1600
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2908
Country : US
Telephone Number : 602-323-3344
Fax Number : 602-323-3496
Provider Business Practice Location Address
First Line : 3830 E VAN BUREN ST
Second Line :
City : PHOENIX
State : AZ
Zip : 85008-6920
Country : US
Telephone Number : 602-243-7277
Fax Number : 602-286-0808
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 01/26/2021

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