Provider Demographics
NPI:1134232879
Name:DANHIRES, BRYAN W (DPM)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:W
Last Name:DANHIRES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BUCKHANNON PIKE
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-3947
Mailing Address - Country:US
Mailing Address - Phone:304-623-1991
Mailing Address - Fax:304-622-6824
Practice Address - Street 1:1 STADIUM DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-598-4800
Practice Address - Fax:304-293-6963
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00371213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2102035000Medicaid
WVP00083673OtherMCRRRB
WV2102035000Medicaid
WV5050250001Medicare NSC
WVP00083673OtherMCRRRB