Individual
JACOB DANIEL CHANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1327 TROUP HWY, TYLER, TX 75701-4443
(903) 510-8840
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA02875
TX
Other
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
Enumeration date
06/12/2006
Last updated
04/23/2025
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