Provider Type Icon

BASIL D. FOSSUM M.D. F.A.C.S. NPI 1235326026


NPI Information

NPI: 1235326026
Provider Name: BASIL D. FOSSUM, M.D., F.A.C.S.

Doing Business As: DR. FOSSUM

Classification: Urology - 208800000X
Entity Type: Organization
Address:
914 MAR WALT DR STE B
FORT WALTON BEACH, FL
ZIP 32547
Phone: (850) 266-5722
Get Directions

BASIL D. FOSSUM, M.D., F.A.C.S. is an urology in Fort Walton Beach, FL. The provider is 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. BASIL D. FOSSUM, M.D., F.A.C.S. NPI is 1235326026. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Dr. Fossum.

The provider's business location address is:

914 MAR WALT DR STE B
FORT WALTON BEACH, FL
ZIP 32547-706
Phone: (850) 266-5722
Fax: (850) 862-8564

The provider's authorized official is April Hughes .
The authorized official title is Office Manager and has the following contact phone number (850) 226-6572.

The enumeration date for this NPI number is 9/26/2007 and was last updated on 12/14/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208800000XUrologyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1ME53505OTHERFLORIDAMEDICAL LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.