Organization · Type 2 NPI

Basil D. Fossum, M.d. PA

Urology Physician · Fort Walton Beach, FL

NPI number 1154911527 Active

Practice location

914 Mar Walt Dr Ste B
Fort Walton Beach, FL 32547-6706

Fax (850) 862-8564

Specialties and licenses

Taxonomy	Code	License
Urology Physician Primary	208800000X	None listed

Urology Physician: A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

Another provider at this address

Basil D. Fossum, M.d., F.a.c.s.Urology Physician Fort Walton Beach, FL NPI 1235326026

Other urology physician providers in Fort Walton Beach

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NPI record

NPI: 1154911527
Entity type: Organization (Type 2)
Issued: Jan 20, 2021
Last updated: May 22, 2025
Status: Active

Other names

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Basil D. Fossum, M.d. · doing business as
Basil D. Fossum, M.d. · doing business as

Authorized official

Dr. Basil Duane Fossum MD PA, MD
Owner
(850) 862-2555

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About NPI 1154911527

Basil D. Fossum, M.d. PA's National Provider Identifier is 1154911527, issued on Jan 20, 2021. The primary taxonomy on file is Urology Physician (208800000X), and the practice location is in Fort Walton Beach, FL. The record was last updated on May 22, 2025.