Provider Demographics
NPI:1215920855
Name:KRUSE, JOHN JUDE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JUDE
Last Name:KRUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-579-5459
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:1520 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2208
Practice Address - Country:US
Practice Address - Phone:985-646-0945
Practice Address - Fax:985-643-8510
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS22519207T00000X
TNMD0000031606207T00000X
MO2013003221207T00000X
LA10605R207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS972784OtherWINDSOR
MSP01206664OtherRAILROAD MEDICARE
MS08876201Medicaid
MS5158737OtherAETNA
MSH00316OtherHEALTHSPRING
MS1904791OtherUNITED HEALTHCARE OF MS
MS2150375OtherCIGNA
TN3841586Medicaid
MSP01206664OtherRAILROAD MEDICARE
MS5158737OtherAETNA
TN3841586Medicaid