Provider Demographics
NPI:1386620532
Name:NOBACK, CARL R (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:R
Last Name:NOBACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 MIDNIGHT PASS RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34242-3083
Mailing Address - Country:US
Mailing Address - Phone:561-400-9900
Mailing Address - Fax:888-398-3187
Practice Address - Street 1:5700 MIDNIGHT PASS RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34242-3083
Practice Address - Country:US
Practice Address - Phone:561-400-9900
Practice Address - Fax:888-398-3187
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82169207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL76568ROtherMEDICARE
NVC96399Medicare UPIN
FLC96399Medicare UPIN