# KEITH ALLAN NOBACK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1154437317
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 51526 | AZ | Yes |
| 207Q00000X | Family Medicine Physician | 6371A | WY | — |

## Other

- **Enumeration date:** 08/21/2006
- **Last updated:** 01/26/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 111718 | — | AZ |
| 05 | — | 115373100 | — | WY |