Provider Demographics
NPI:1326007709
Name:RUEGEMER, J JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:JEFFREY
Last Name:RUEGEMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7701 YORK AVE S
Mailing Address - Street 2:SUITE 180
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5845
Mailing Address - Country:US
Mailing Address - Phone:952-927-7810
Mailing Address - Fax:952-927-6309
Practice Address - Street 1:7701 YORK AVE S
Practice Address - Street 2:SUITE 180
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5845
Practice Address - Country:US
Practice Address - Phone:952-927-7810
Practice Address - Fax:952-927-6309
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25479174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN171295100Medicaid
MN53968RUOtherBLUE CROSS BLUE SHIELD
MN3317034OtherMEDICA CHOICE
MN115602C626OtherUCARE
MN0256006OtherSELECT CARE
MN108479OtherPATIENT CHOICE
MN960540799003OtherPREFERRED ONE
MNHP14289OtherHEALTH PARTNER
MN21003OtherAMERICA'S PPO
MN3300003OtherMEDICA PRIMARY
FM410999025OtherTRICARE
MN960540799003OtherPREFERRED ONE
MN53968RUOtherBLUE CROSS BLUE SHIELD
MN3300003OtherMEDICA PRIMARY