Healthcare Provider Details

I. General information

NPI: 1780203893
Provider Name (Legal Business Name): JAMES HAYWARD PORTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16901 LAKESIDE HILLS CT
OMAHA NE
68130-2318
US

IV. Provider business mailing address

16901 LAKESIDE HILLS CT
OMAHA NE
68130-2318
US

V. Phone/Fax

Practice location:
  • Phone: 402-717-8111
  • Fax: 402-717-8127
Mailing address:
  • Phone: 402-717-8111
  • Fax: 402-717-8127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT220340
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD222863
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number37016
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: