Organization
ROCKWOOD FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARRY LEE OTEHAM D.O. (OWNER)
(636) 529-9595
Entity
Organization
Contact information
Practice address
1747 SMIZER STATION RD, SUITE 3B, FENTON, MO 63026-2784
(636) 529-9595
(636) 529-9494
Mailing address
1747 SMIZER STATION RD, FENTON, MO 63026-2784
(636) 529-9595
(636) 529-9494
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
199913565
MO
Other
Enumeration date
04/01/2008
Last updated
12/17/2008
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