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General NPI Number Information
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NPI Number | 1912435199
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Entity Type | Individual
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Provider Name | DOMINIQUE JORDAN RAZEEQ MD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 11/21/2025
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Provider Practice Location Address
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Address Line | 6801 DIXIE HWY STE 135
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City | LOUISVILLE
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State | KY
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Zip | 40258-3952
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Country | US
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Telephone | 502-791-8700
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Fax | 502-742-8523
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Provider Business Mailing Address
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Address Line | 7951 SHOAL CREEK BLVD STE 300
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City | AUSTIN
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State | TX
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Zip | 78757-7582
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Country | US
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Telephone | 512-584-8404
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Fax | 737-377-0442
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 58741
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License Number State | KY
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