Provider Demographics
NPI:1407965668
Name:WHYTE, BRIAN R (MD,)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:R
Last Name:WHYTE
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 1:122 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2608
Mailing Address - Country:US
Mailing Address - Phone:304-250-0382
Mailing Address - Fax:304-250-0383
Practice Address - Street 1:122 GEORGE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2608
Practice Address - Country:US
Practice Address - Phone:304-250-0382
Practice Address - Fax:304-250-0383
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22852208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009721Medicaid
WVWH4226431Medicare PIN
F70454Medicare UPIN