Individual
DR. CORNELIA SELMA DE RIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, PHD, MBA
Contact information
Practice address
701 W 5TH ST, ODESSA, TX 79763-4206
(432) 335-2222
(432) 335-1009
Mailing address
701 W 5TH ST # 3212, ODESSA, TX 79763-4206
(432) 703-5000
(432) 335-5240
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
L6348
TX
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
L6348
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K5175
—
NM
05
—
100048670A
—
OK
05
—
103816802
—
TX
05
—
103816803
—
TX
05
—
111572100
—
TX
01
—
111572101
FIRSTCARE COMMERCIAL
TX
01
—
80833Z
HMO BLUE
TX
01
—
83G037
BC/BS
TX
01
—
84497
PRESBYTERIAN COMMERCIAL
NM
05
—
84497
—
NM
01
—
A117
TRIWEST
NM
Enumeration date
10/24/2005
Last updated
04/30/2021
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