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Organization
PREMISE HEALTH OF TEXAS MEDICAL, P.A
Active
Organization
PREMISE HEALTH OF TEXAS MEDICAL, P.A
Active
Other names
Goodyear Family Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON LEIZMAN M.D. (PRESIDENT)
(216) 479-9063
Entity
Organization
Contact information
Practice address
HWY 31 WEST FM206, TYLER, TX 75709
(903) 592-3257
(903) 592-3447
Mailing address
5500 MARYLAND WAY STE 120, BRENTWOOD, TN 37027-4993
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0069HJ
PRACTICE BCBS NUMBER
TX
Enumeration date
11/22/2006
Last updated
08/23/2022
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