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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	58741	KY

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	:	6801 DIXIE HWY STE 135
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40258-3952
Country	:	US
Telephone Number	:	502-791-8700
Fax Number	:	502-742-8523

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

Provider Enumeration Date	:	05/31/2017
Last Update Date	:	11/21/2025

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