Individual
KEITH ALLAN NOBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3830 E VAN BUREN ST, PHOENIX, AZ 85008-6920
(602) 243-7277
(602) 286-0808
Mailing address
3003 N CENTRAL AVE STE 1600, PHOENIX, AZ 85012-2908
(602) 323-3344
(602) 323-3496
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
51526
AZ
207Q00000X
Family Medicine Physician
6371A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111718
—
AZ
05
—
115373100
—
WY
Enumeration date
08/21/2006
Last updated
01/26/2021
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