Fossum Md Pa, Basil D.

Fossum Md Pa, Basil D. is an individual health care provider with primary practice located at 914B Mar Walt Dr , Fort Walton Beach FL 32547-6706. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Urology. Allopathic & Osteopathic Physicians / Urology is his primary health care specialty. Fossum Md Pa, Basil D. can be contacted via phone (850) 226-6572.

Contact Information

Primary practice address
914B Mar Walt Dr Fort Walton Beach FL 32547-6706
Phone: (850) 226-6572
Fax: (850) 862-8564
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X ME53505 Florida
Allopathic & Osteopathic Physicians / Urology 208800000X ME53505 Florida

Profile Details

NPI number 1821043811
LBN Legal business name Fossum Md Pa, Basil D.
Credentials M.D., F.A.C.S.
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2006
Last updated Apr 1st, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821043811 NPPES
Florida Other 593-08600 BCBS AL
Florida Other 07317 BCBS AL
Florida Other P00990540 BCBS AL
Florida Other 1193041 BCBS AL
Florida Other 159401 BCBS AL
Florida Other 4266997 BCBS AL

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