Healthcare Provider Details

I. General information

NPI: 1881935781
Provider Name (Legal Business Name): DONALD LLOYD CHANEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 MEADOW LANE
HIGHLAND IL
62249
US

IV. Provider business mailing address

3833 MEADOW LANE
HIGHLAND IL
62249
US

V. Phone/Fax

Practice location:
  • Phone: 618-654-8206
  • Fax: 618-654-9581
Mailing address:
  • Phone: 618-654-8206
  • Fax: 618-654-9581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036040740
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: