Provider Demographics
NPI:1801863709
Name:CHAMNESS, JIMMY MARTIN II (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:MARTIN
Last Name:CHAMNESS
Suffix:II
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:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75606-0614
Mailing Address - Country:US
Mailing Address - Phone:903-247-2050
Mailing Address - Fax:903-934-8280
Practice Address - Street 1:2901 N. 4TH ST.
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5128
Practice Address - Country:US
Practice Address - Phone:903-247-2050
Practice Address - Fax:903-934-8280
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8043207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122530205Medicaid
TX122530205Medicaid
TX87815NMedicare ID - Type Unspecified