Basil D. Fossum, M.D.

LBN: Basil D. Fossum, M.D. Pa
Basil D. Fossum, M.D. is an health care organization with primary practice located at 914 Mar Walt Dr Ste B , Fort Walton Beach FL 32547-6706. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Urology, which is considered as the primary health care specialty. Basil D. Fossum, M.D. Pa can be contacted via phone (850) 226-6572, or through Fossum Md Pa, Basil D. via phone (850) 862-2555.

Contact Information

Primary practice address
914 Mar Walt Dr Ste B Fort Walton Beach FL 32547-6706
Phone: (850) 226-6572
Fax: (850) 862-8564
Website:
Map and Directions
Authorized official contact:
Name: Fossum Md Pa, Basil D. Doctor of Medicine (MD)
Phone: (850) 862-2555

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X

Profile Details

NPI number 1154911527
LBN Legal business name Basil D. Fossum, M.D. Pa
DBA Doing business as Basil D. Fossum, M.D.
Authorized official Fossum Md Pa, Basil D. Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Jan 20th, 2021
Last updated Apr 1st, 2021 - about 3 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154911527 NPPES
Florida Other ME53505 MEDICAL LICENSE

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