Provider Demographics
NPI:1003976630
Name:NOBES, PETER RICHARD (PA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:RICHARD
Last Name:NOBES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 SPEAR ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:VT
Mailing Address - Zip Code:05445-8221
Mailing Address - Country:US
Mailing Address - Phone:802-425-2260
Mailing Address - Fax:
Practice Address - Street 1:32 MALLETTS BAY AVE
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1959
Practice Address - Country:US
Practice Address - Phone:802-655-4422
Practice Address - Fax:802-861-2678
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT055-0030117363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT055-0031041OtherVT. PHYSICIAN ASSISTANT CERTIFICATE
VT055-0031041OtherVT. PHYSICIAN ASSISTANT CERTIFICATE