Provider Demographics
NPI:1841367810
Name:FROST, JANICE L (MD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:L
Last Name:FROST
Suffix:
Gender:F
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:WILLAMETTE CARDIOLOGY
Mailing Address - Street 2:410-A NW WALNUT BLVD
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3890
Mailing Address - Country:US
Mailing Address - Phone:541-753-9497
Mailing Address - Fax:541-753-7732
Practice Address - Street 1:410 NW WALNUT BLVD
Practice Address - Street 2:STE A
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3890
Practice Address - Country:US
Practice Address - Phone:541-753-9497
Practice Address - Fax:541-753-7732
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 16473207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR010475Medicaid
9312449006OtherTAX ID NUMBER
9312449006OtherTAX ID NUMBER
ORR101972Medicare ID - Type Unspecified