# BOULDER PEAK FAMILY PRACTICE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669705042
- **Authorized official:** DR. MARK A. WISNER D.O. (PRESIDENT)
- **Authorized official phone:** (303) 543-1111

## Contact information

- **Practice address:** 5330 MANHATTAN CIR \# C-2, BOULDER, CO 80303-4240
- **Practice address phone:** (303) 543-1111
- **Practice address fax:** (303) 543-1112
- **Mailing address:** 5330 MANHATTAN CIR \# C-2, BOULDER, CO 80303-4240
- **Mailing address phone:** (303) 543-1111
- **Mailing address fax:** (303) 543-1112

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 44052 | CO | Yes |

## Other

- **Enumeration date:** 09/16/2009
- **Last updated:** 09/16/2009