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Basil D. Fossum Md Pa, MD,FACS
Urology Physician in Fort Walton Beach, Florida
NPI 1821043811

Basil D. Fossum Md Pa is a Urology Physician based in Fort Walton Beach, FL. Basil D. Fossum Md Pa practices in Fort Walton Beach, FL and has the professional credentials of MD,FACS. The NPI Number for Basil D. Fossum Md Pa is 1821043811 and holds a License No. ME53505 (Florida).

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

Location: 914B Mar Walt Dr, Fort Walton Beach, FL, 32547-6706
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1821043811
Provider Name
Basil D. Fossum Md Pa
Credential
MD,FACS
Provider Entity Type
Individual
Gender
Male
Address
914B Mar Walt Dr, Fort Walton Beach, FL, 32547-6706
Phone Number
850-226-6572
Fax Number
850-862-8564
Provider Enumeration Date
05/24/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
593-08600 01 FL BCBS AL
07317 01 FL BCBS FL
P00990540 01 FL RAILROAD MEDICARE
1193041 01 FL WELLCARE
159401 01 FL UNIVERSAL HEALTHCARE
4266997 01 FL AETNA THRU EMERALD COAST HEALTH ALLIANCE
institution
Provider Business Practice Location Address Details
Address
914B Mar Walt Dr
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
914B Mar Walt Dr
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
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
ME53505 (Florida)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
Urology
Speciality
-
Taxonomy
208800000X
License No.
ME53505 (Florida)
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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