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General NPI Number Information
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NPI Number | 1750313904
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Entity Type | Individual
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Provider Name | JO ELLEN REEVES KRUEGER MD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 05/13/2014
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Provider Practice Location Address
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Address Line | 7777 FOREST LANE
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City | DALLAS
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State | TX
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Zip | 75230
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Country | US
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Telephone | 972-739-7445
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Fax | 214-692-7478
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Provider Business Mailing Address
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Address Line | PO BOX 496148
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City | GARLAND
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State | TX
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Zip | 75049-6148
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Country | US
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Telephone | 972-739-7445
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Fax | 214-692-7478
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | K6967
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License Number State | TX
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