Provider Demographics
NPI:1295916047
Name:BRYAN W. DANHIRES, DPM PLLC
Entity type:Organization
Organization Name:BRYAN W. DANHIRES, DPM PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DANHIRES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-623-1991
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 1:300 BUCKHANNON PIKE
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-3947
Practice Address - Country:US
Practice Address - Phone:304-623-1991
Practice Address - Fax:304-622-6824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 000371213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVBR9341401OtherMEDICARE GROUP
WVDB0339OtherMCRRRB
WV2102035000Medicaid
WVBR9341401OtherMEDICARE GROUP
WVU91685Medicare UPIN
WV2102035000Medicaid