Provider Demographics
NPI:1447290861
Name:DIMITROV, DRAGAN F (MD)
Entity type:Individual
Prefix:DR
First Name:DRAGAN
Middle Name:F
Last Name:DIMITROV
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 1:12 UPPER RAGSDALE DR
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5730
Mailing Address - Country:US
Mailing Address - Phone:831-648-7200
Mailing Address - Fax:
Practice Address - Street 1:12 UPPER RAGSDALE DR
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5730
Practice Address - Country:US
Practice Address - Phone:831-648-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82908207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH87119Medicare UPIN
CA00A829082Medicare PIN
CA00A829080Medicare ID - Type Unspecified