MEDICARE: DR. ADAM DIMITROV 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	207Q00000X	Family Medicine Physician	ME102216	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00710723	OTHER	FL	RR MEDICARE

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962471938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM DIMITROV MD

Provider Business Mailing Address
First Line	:	PO BOX 45443
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84145-0443
Country	:	US
Telephone Number	:	904-202-1032
Fax Number	:	904-376-4107

Provider Business Practice Location Address
First Line	:	13000 SAWGRASS VILLAGE CIR STE 46
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5023
Country	:	US
Telephone Number	:	904-202-6348
Fax Number	:	904-376-3019

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	11/22/2024

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Directions to “ DR. ADAM DIMITROV MD” Practice Location

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