Healthcare Provider Details

I. General information

NPI: 1518604644
Provider Name (Legal Business Name): ARTEM FROLOV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 82ND DR STE 100
GLADSTONE OR
97027-2550
US

IV. Provider business mailing address

15 82ND DR STE 100
GLADSTONE OR
97027-2550
US

V. Phone/Fax

Practice location:
  • Phone: 503-853-0209
  • Fax:
Mailing address:
  • Phone: 503-853-0209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number4655
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberDO229924
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: