NPIMap

Organization Active NPI

Boulder Peak Family Practice, Inc.

  • Family Medicine Physician
  • Boulder, CO
National Provider Identifier
1669705042
Registry record updated Sep 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
44052 Issued in CO
Legal business name
BOULDER PEAK FAMILY PRACTICE, INC.
Practice address
5330 Manhattan Cir # C-2
Boulder, CO 80303-4240
Phone
(303) 543-1111
Fax
(303) 543-1112
NPI assigned
Sep 16, 2009
Last updated
Sep 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark A. Wisner, D.O.
Title
President
Phone
(303) 543-1111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 44052 CO Primary

Addresses

Primary practice location

5330 Manhattan Cir # C-2
Boulder, CO 80303-4240

Mailing address

5330 Manhattan Cir # C-2
Boulder, CO 80303-4240
Phone (303) 543-1111

National Provider Directory

National Provider Directory

Locations

5330 Manhattan Cir
Ste C2
Boulder, CO 80303
Phone (303) 543-1111

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253059200000",
    "number": "1669705042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5330 MANHATTAN CIR # C-2",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803034240",
            "telephone_number": "303-543-1111",
            "fax_number": "303-543-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5330 MANHATTAN CIR # C-2",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803034240",
            "telephone_number": "303-543-1111",
            "fax_number": "303-543-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER PEAK FAMILY PRACTICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-16",
        "last_updated": "2009-09-16",
        "status": "A",
        "authorized_official_last_name": "WISNER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-543-1111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "44052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.