Provider Demographics
NPI:1073560058
Name:PORTER, HOMA JACKSON II (MD)
Entity Type:Individual
Prefix:DR
First Name:HOMA
Middle Name:JACKSON
Last Name:PORTER
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAKE
Other - Middle Name:
Other - Last Name:PORTER
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:8230 WALNUT HILL LN
Practice Address - Street 2:SUITE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4482
Practice Address - Country:US
Practice Address - Phone:214-691-1902
Practice Address - Fax:214-987-1845
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8894208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00129571OtherRRMCR
TX168549702Medicaid
TX168549701Medicaid
8M6732OtherBCBS PROVIDER ID
I08684Medicare UPIN
TXP00129571OtherRRMCR
TX168549702Medicaid
8M6732OtherBCBS PROVIDER ID