Provider Demographics
NPI:1912435199
Name:RAZEEQ, DOMINIQUE JORDAN (MD)
Entity type:Individual
Prefix:DR
First Name:DOMINIQUE
Middle Name:JORDAN
Last Name:RAZEEQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7951 SHOAL CREEK BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7582
Mailing Address - Country:US
Mailing Address - Phone:512-584-8404
Mailing Address - Fax:737-377-0442
Practice Address - Street 1:6801 DIXIE HWY STE 135
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3952
Practice Address - Country:US
Practice Address - Phone:502-791-8700
Practice Address - Fax:502-742-8523
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY58741207LP2900X, 207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program