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NPI Verification

National Provider Identifier: 1154911527

Basil D. Fossum, M.d. PA

Organization

Primary Specialty

Urology

Code: 208800000X

Practice Address

914 MAR WALT DR STE B

FORT WALTON BEACH, FL 325476706

Phone: 850-862-2555

NPI Enumeration Date

January 20, 2021

NPI Number

1154911527

Data sourced from the official CMS NPPES Registry. This information is provided by the Centers for Medicare & Medicaid Services and is updated regularly.

View on CMS NPPES Registry