BASIL FOSSUM
Urology
Active
Individual
NPI: 1821043811
Specialties
| Specialty | Code | Primary | License |
|---|---|---|---|
| Specialist | 174400000X | No | ME53505 (FL) |
| Urology | 208800000X | Yes | ME53505 (FL) |
Frequently Asked Questions
NPI 1821043811 is the National Provider Identifier for BASIL FOSSUM, a Urology provider located in Fort Walton Beach, FL. This NPI was enumerated on May 24, 2006.
BASIL FOSSUM practices at 914B MAR WALT DR, Fort Walton Beach, FL 32547.
Quick Facts
- NPI
- 1821043811
- Type
- Individual
- Enumerated
- May 24, 2006
- Last Updated
- Jan 5, 2026
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