Julie Shibata Fall, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

3686A Issued in WY

Practice address

1308 W 4TH St
Gillette, WY 82716-3330

Phone

(307) 687-1300

Fax

(307) 682-1309

NPI assigned

Aug 16, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Big Horn Pediatrics

  • Pediatrics Physician
  • Gillette, WY
  • NPI 1477660447

  Adolescent Medicine

  NPD (past)

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1306959267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1308 W 4TH ST",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163330",
            "telephone_number": "307-687-1300",
            "fax_number": "307-682-1309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 W 4TH ST",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163330",
            "telephone_number": "307-687-1300",
            "fax_number": "307-682-1309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALL",
        "first_name": "JULIE",
        "middle_name": "SHIBATA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "WY",
            "license": "3686A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "302313",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eye Care Associates of Wyoming, P.C.
• Julie Ann Faldalen, LPN
• Annette Falkman
• Craig Dean Falkman, M.A., L.P.C.
• David Robert Fall, M.D.
• Family Medical Care LLC
• Brittany J Farella, PT
• Faubion Chiropractic PC
• Jack E Faubion, DC
• Kimberly Faucett, RPH

• Pediatric Adolescent Medicine Physician in Gillette, WY
• Providers in Gillette, WY by specialty
• Pediatric Adolescent Medicine Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.