# ROCKWOOD FAMILY MEDICINE LLC

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

## Provider details

- **NPI number:** 1023280856
- **Authorized official:** DR. LARRY LEE OTEHAM D.O. (OWNER)
- **Authorized official phone:** (636) 529-9595

## Contact information

- **Practice address:** 1747 SMIZER STATION RD, SUITE 3B, FENTON, MO 63026-2784
- **Practice address phone:** (636) 529-9595
- **Practice address fax:** (636) 529-9494
- **Mailing address:** 1747 SMIZER STATION RD, FENTON, MO 63026-2784
- **Mailing address phone:** (636) 529-9595
- **Mailing address fax:** (636) 529-9494

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 199913565 | MO | Yes |

## Other

- **Enumeration date:** 04/01/2008
- **Last updated:** 12/17/2008