Provider Demographics
NPI:1780203893
Name:PORTER, JAMES HAYWARD (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HAYWARD
Last Name:PORTER
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 1:16901 LAKESIDE HILLS CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2318
Mailing Address - Country:US
Mailing Address - Phone:402-717-8111
Mailing Address - Fax:402-717-8127
Practice Address - Street 1:16901 LAKESIDE HILLS CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2318
Practice Address - Country:US
Practice Address - Phone:402-717-8111
Practice Address - Fax:402-717-8127
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT220340207P00000X
ORMD222863207P00000X
390200000X
NE37016207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program