| Rockwood Family Medicine Llc | |
|
1747 Smizer Station Rd Suite 3b Fenton MO 63026-2784 | |
| (636) 529-9595 | |
| (636) 529-9494 |
| Full Name | Rockwood Family Medicine Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1747 Smizer Station Rd, Fenton, Missouri |
| Authorized Official Name and Position | Larry Lee Oteham (OWNER) |
| Authorized Official Contact | 6365299595 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rockwood Family Medicine Llc 1747 Smizer Station Rd Fenton MO 63026-2784 Ph: (636) 529-9595 | Rockwood Family Medicine Llc 1747 Smizer Station Rd Suite 3b Fenton MO 63026-2784 Ph: (636) 529-9595 |
| NPI Number | 1023280856 |
|---|---|
| Provider Enumeration Date | 04/01/2008 |
| Last Update Date | 12/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023280856 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 199913565 (Missouri) | Primary |
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