Individual provider · NPI-1

Myra Dimitrov Dimitrov, M.D.

Family Medicine · Palmer, AK

NPI number1134548464
StatusActive
Last updated in NPPESNov 8, 2019

Details

NPI
1134548464
Entity type
Individual (NPI-1)
Name
Myra Dimitrov Dimitrov
Credential
M.D.
Sex
Female
Sole proprietor
Yes
Enumeration date
Apr 15, 2014
Last updated
Nov 8, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine125163AKYes

Practice location

2323 S Trunk Rd Apt 6
Palmer, AK 99645

Phone 907-746-6644

Mailing address

2323 S Trunk Rd Apt 6
Palmer, AK 99645-5940

Phone 907-746-6644

Other practice locations

104 W 5th Ave
Ste 200w
Spokane, WA 99204-4880

Phone 509-624-2313 · Fax 509-459-0686

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