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Organization
PREMISE HEALTH OF OKLAHOMA MEDICAL, P.C
Active
Organization
PREMISE HEALTH OF OKLAHOMA MEDICAL, P.C
Active
Other names
Goodyear Family Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
JON LEIZMAN (PRESIDENT)
(216) 479-9063
Entity
Organization
Contact information
Practice address
901 SW GOODYEAR BLVD, LAWTON, OK 73505-9755
(580) 510-6361
(580) 531-5779
Mailing address
5500 MARYLAND WAY STE 120, BRENTWOOD, TN 37027-4993
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/09/2006
Last updated
10/13/2022
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