MEDICARE: DR. DIMTCHO V POPOV 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	207RN0300X	Nephrology Physician	343543	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740289230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIMTCHO V POPOV MD

Provider Business Mailing Address
First Line	:	3368 HIGHWAY 280
Second Line	:	SUITE G-10
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-3393
Country	:	US
Telephone Number	:	256-409-1500
Fax Number	:	256-409-1144

Provider Business Practice Location Address
First Line	:	711 WOOD ST STE A
Second Line	:
City	:	MONROE
State	:	LA
Zip	:	71201-7564
Country	:	US
Telephone Number	:	318-323-8847
Fax Number	:	318-387-8804

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/10/2025

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