# CORNELIA S DERIESE MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053789990
- **Authorized official:** DR. CORNELIA S DERIESE MD PA (OWNER)
- **Authorized official phone:** (888) 753-5988

## Contact information

- **Practice address:** 3814 24TH ST, LUBBOCK, TX 79410-1814
- **Practice address phone:** (806) 553-7950
- **Practice address fax:** (623) 777-4593
- **Mailing address:** 2708 27TH ST, LUBBOCK, TX 79410-2229
- **Mailing address phone:** (888) 753-5988
- **Mailing address fax:** (623) 777-4593

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | L6348 | TX | Yes |

## Other

- **Enumeration date:** 09/09/2015
- **Last updated:** 09/09/2015