MEDICARE: DR. JULIE ANN CARLSON M.D.

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	207R00000X	Internal Medicine Physician	5393A	WY

General Provider Information

NPI Number	:	1376530204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE ANN CARLSON M.D.

Provider Business Mailing Address
First Line	:	1168 DUTTON CT
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82072-5301
Country	:	US
Telephone Number	:	307-745-3955
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 E UNIVERSITY AVE
Second Line	:	UNIVERSITY OF WYOMING STUDENT HEALTH
City	:	LARAMIE
State	:	WY
Zip	:	82071-2000
Country	:	US
Telephone Number	:	307-766-2130
Fax Number	:	307-766-2711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	07/08/2007

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