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Basil D. Fossum, M.d. Pa
Urology Physician in Fort Walton Beach, Florida
NPI 1154911527

Basil D. Fossum, M.d. Pa is a Urology Physician based in Fort Walton Beach, FL. Basil D. Fossum, M.d. Pa practices in Fort Walton Beach, FL. The NPI Number for Basil D. Fossum, M.d. Pa is 1154911527 and holds a License No. (Florida).

The current practice location address for Basil D. Fossum, M.d. Pa is 914 Mar Walt Dr Ste B, Fort Walton Beach, FL and can be reached out via phone at 850-226-6572 and via fax at 850-862-8564.

Location: 914 Mar Walt Dr Ste B, Fort Walton Beach, FL, 32547-6706
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1154911527
Provider Name
Basil D. Fossum, M.d. Pa
Credential
Provider Entity Type
Organization
Address
914 Mar Walt Dr Ste B, Fort Walton Beach, FL, 32547-6706
Phone Number
850-226-6572
Fax Number
850-862-8564
Provider Enumeration Date
01/20/2021
Last Update Date
03/10/2024
tick
Provider's Legacy Identifiers
Identifier Type State Issuer
ME53505 01 FL MEDICAL LICENSE
institution
Provider Business Practice Location Address Details
Address
914 Mar Walt Dr Ste B
City
Fort Walton Beach
State
Florida
Zip
32547-6706
Phone Number
850-226-6572
Fax Number
850-862-8564
person
Provider Business Mailing Address Details
Address
914 Mar Walt Dr Ste B
City
Fort Walton Beach
State
Florida
Zip
32547-6706
Phone Number
850-226-6572
Fax Number
850-862-8564
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Urology
Speciality
-
Taxonomy
208800000X
License No.
()
Definition
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.
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