Provider Demographics
NPI:1740289230
Name:POPOV, DIMTCHO V (MD)
Entity type:Individual
Prefix:DR
First Name:DIMTCHO
Middle Name:V
Last Name:POPOV
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 1:3368 HIGHWAY 280
Mailing Address - Street 2:SUITE G-10
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-3393
Mailing Address - Country:US
Mailing Address - Phone:256-409-1500
Mailing Address - Fax:256-409-1144
Practice Address - Street 1:3368 HIGHWAY 280
Practice Address - Street 2:SUITE G-10
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3393
Practice Address - Country:US
Practice Address - Phone:256-409-1500
Practice Address - Fax:256-409-1144
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20515174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529917040Medicaid
AL051516344Medicare ID - Type Unspecified
AL529917040Medicaid