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NPI Code Detail

MEDICARE: DR. DOMINIQUE JORDAN RAZEEQ MD

MEDICARE: DR. DOMINIQUE JORDAN RAZEEQ MD
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
1207LP2900XPain Medicine (Anesthesiology) Physician58741KY

General Provider Information

NPI Number : 1912435199
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOMINIQUE JORDAN RAZEEQ MD
Provider Business Mailing Address
First Line : 7951 SHOAL CREEK BLVD STE 300
Second Line :
City : AUSTIN
State : TX
Zip : 78757-7582
Country : US
Telephone Number : 512-584-8404
Fax Number : 737-377-0442
Provider Business Practice Location Address
First Line : 4000 KRESGE WAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40207-4605
Country : US
Telephone Number : 502-330-0831
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2017
Last Update Date : 06/25/2026

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