Cornelia S Deriese MD PA

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

L6348 Issued in TX

Legal business name

CORNELIA S DERIESE MD PA

Practice address

3814 24TH St
Lubbock, TX 79410-1814

Phone

(806) 553-7950

Fax

(623) 777-4593

NPI assigned

Sep 9, 2015

Last updated

Sep 9, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Cornelia S Deriese, MD PANPI 1841280716

Title

Owner

Phone

(888) 753-5988

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Cornelia Selma De Riese, MD, PHD, MBA

  • Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
  • Odessa, TX
  • NPI 1841280716
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441756800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441756800000",
    "number": "1053789990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2708 27TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794102229",
            "telephone_number": "888-753-5988",
            "fax_number": "623-777-4593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3814 24TH ST",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101814",
            "telephone_number": "806-553-7950",
            "fax_number": "623-777-4593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELIA S DERIESE MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-09",
        "last_updated": "2015-09-09",
        "status": "A",
        "authorized_official_last_name": "DERIESE",
        "authorized_official_first_name": "CORNELIA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "888-753-5988",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD PA"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "TX",
            "license": "L6348",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Brian Adrian Cornwell, FNP

• Obstetrics & Gynecology Physician in Lubbock, TX
• Providers in Lubbock, TX by specialty
• Obstetrics & Gynecology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.