Individual
DR. JULIE SHIBATA FALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1308 W 4TH ST, GILLETTE, WY 82716-3330
(307) 687-1300
(307) 682-1309
Mailing address
1308 W 4TH ST, GILLETTE, WY 82716-3330
(307) 687-1300
(307) 682-1309
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
3686A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
302313
BCBS PROVIDER NUMBER
WY
Enumeration date
08/16/2006
Last updated
07/09/2007
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