Provider Demographics
NPI:1124029160
Name:CHANEY, BRIAN WAYNE (MD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:WAYNE
Last Name:CHANEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MEDICAL CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:KY
Mailing Address - Zip Code:42367
Mailing Address - Country:US
Mailing Address - Phone:270-377-1608
Mailing Address - Fax:270-377-1681
Practice Address - Street 1:1010 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:POWDERLY
Practice Address - State:KY
Practice Address - Zip Code:42367
Practice Address - Country:US
Practice Address - Phone:270-377-1608
Practice Address - Fax:270-377-1681
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64048325Medicaid
KY0652414Medicare PIN
KY64048325Medicaid