Provider Demographics
NPI:1750313904
Name:KRUEGER, JO ELLEN REEVES (MD)
Entity Type:Individual
Prefix:DR
First Name:JO ELLEN
Middle Name:REEVES
Last Name:KRUEGER
Suffix:
Gender:F
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:PO BOX 496148
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75049-6148
Mailing Address - Country:US
Mailing Address - Phone:972-739-7445
Mailing Address - Fax:214-692-7478
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-739-7445
Practice Address - Fax:214-692-7478
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6967207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8301M1OtherBLUE CROSS
TX145513101Medicaid
TX8301M1Medicare ID - Type Unspecified
TX8301M1OtherBLUE CROSS