Provider Demographics
NPI:1689623159
Name:MORRIS, BOOKER TALFORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:BOOKER
Middle Name:TALFORIA
Last Name:MORRIS
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 1:1215 LAWN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2450
Mailing Address - Country:US
Mailing Address - Phone:574-293-2983
Mailing Address - Fax:574-293-1298
Practice Address - Street 1:1215 LAWN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2450
Practice Address - Country:US
Practice Address - Phone:574-293-2983
Practice Address - Fax:574-293-1298
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063350A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI102585120Medicaid
IN000000655399OtherBCBS WCCC
MI1601110811OtherBCBS OF MI
IN000000520390OtherANTHEM BCBS #
IN200852990Medicaid
IN000000655399OtherBCBS WCCC
A77868Medicare UPIN
INP00441547 RR MCRMedicare PIN