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General NPI Number Information
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NPI Number | 1427112648
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Entity Type | Organization
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Legal Business Name | PREMISE HEALTH OF OKLAHOMA MEDICAL, P.C
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 10/13/2022
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Provider Practice Location Address
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Address Line | 406 E HALL OF FAME AVE
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City | STILLWATER
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State | OK
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Zip | 74075-5428
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Country | US
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Telephone | 800-370-1192
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Fax | 405-707-3015
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Provider Business Mailing Address
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Address Line | 40 BURTON HILLS BLVD SUITE 200
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City | NASHVILLE
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State | TN
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Zip | 37215-6155
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Country | US
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Telephone | 615-565-1733
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Fax | 615-296-0151
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Authorized Official
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Title or Position | PC OWNER
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Name | JONATHAN LEIZMAN
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Credential | M.D.
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Telephone | 216-479-9063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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