Provider Demographics
NPI:1922634120
Name:FRISTOE, FRANK HENDSEN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:HENDSEN
Last Name:FRISTOE
Suffix:JR
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 1:01958 S.W. MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-8334
Mailing Address - Country:US
Mailing Address - Phone:503-635-2621
Mailing Address - Fax:
Practice Address - Street 1:3181 S.W. SAM JACKSON PARK RD.
Practice Address - Street 2:PATHOLOGY DEPT. L113
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-8276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD08003207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology