MEDICARE: DR. JEFFERY KEITH KRUEGER 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	174400000X	Specialist	K6769	TX

General Provider Information

NPI Number	:	1417940099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFERY KEITH KRUEGER M.D.

Provider Business Mailing Address
First Line	:	8220 WALNUT HILL LN
Second Line	:	SUITE 206
City	:	DALLAS
State	:	TX
Zip	:	75231-4427
Country	:	US
Telephone Number	:	214-739-5760
Fax Number	:	214-739-5966

Provider Business Practice Location Address
First Line	:	8220 WALNUT HILL LN
Second Line	:	SUITE 206
City	:	DALLAS
State	:	TX
Zip	:	75231-4427
Country	:	US
Telephone Number	:	214-739-5760
Fax Number	:	214-739-5966

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

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	08/05/2010

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