# JACOB DANIEL CHANEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1114969060
- **Gender:** Man
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | PA02875 | TX | Yes |

## Other

- **Enumeration date:** 06/12/2006
- **Last updated:** 04/23/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 183908601 | — | TX |
| 05 | — | 183908603 | — | TX |
| 01 | — | 75-2616977-042 | TRICARE | TX |
| 01 | — | 776514 | MEDICARE | TX |
| 01 | — | 8Y9987 | BCBS OF TEXAS | TX |