Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Basil D. Fossum, MD PA

Organization Urology Physician · NPI 1154911527

Basil D. Fossum, MD PA is an Urology Physician in Fort Walton Beach, Florida. Registered with an NPI since 2021.

In the registry since
2021
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

914 Mar Walt Dr Ste B
Fort Walton Beach, FL 32547-6706
Phone: (850) 226-6572
Fax: (850) 862-8564
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Urology Physician (primary) Taxonomy 208800000X

Record details

NPI number1154911527
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Basil Fossum Md Pa — Owner · (850) 862-2555
Other names Basil D. Fossum, M.D.; Basil D. Fossum, M.D.
NPI enumeratedJanuary 20, 2021
Last updated in NPPESMay 22, 2025
Certification dateMarch 31, 2021
Mailing address914 Mar Walt Dr Ste B, Fort Walton Beach, FL 32547-6706

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