Healthcare Provider Details

I. General information

NPI: 1740289230
Provider Name (Legal Business Name): DIMTCHO V POPOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 WOOD ST STE A
MONROE LA
71201-7564
US

IV. Provider business mailing address

3368 HIGHWAY 280 SUITE G-10
ALEXANDER CITY AL
35010-3393
US

V. Phone/Fax

Practice location:
  • Phone: 318-323-8847
  • Fax: 318-387-8804
Mailing address:
  • Phone: 256-409-1500
  • Fax: 256-409-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number343543
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: