MEDICARE: BOULDER FAMILY PRACTICE CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	18572	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811976186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOULDER FAMILY PRACTICE CLINIC

Provider Business Mailing Address
First Line	:	1000 ALPINE AVE
Second Line	:	#220
City	:	BOULDER
State	:	CO
Zip	:	80304-3406
Country	:	US
Telephone Number	:	303-996-6804
Fax Number	:	303-996-6807

Provider Business Practice Location Address
First Line	:	1000 ALPINE AVE
Second Line	:	#220
City	:	BOULDER
State	:	CO
Zip	:	80304-3406
Country	:	US
Telephone Number	:	303-996-6804
Fax Number	:	303-996-6807

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHILIP FREDERICK WEBER
Credential	:	M.D.
Telephone Number	:	303-996-6804

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	10/02/2007

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Directions to “BOULDER FAMILY PRACTICE CLINIC ” Practice Location

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