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

Basil Fossum MD PA

Organization Urology Physician · NPI 1184594962

Basil Fossum MD PA is an Urology Physician in Fort Walton Beach, Florida. Registered with an NPI since 2025.

In the registry since
2025
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

914B Mar Walt Dr
Fort Walton Beach, FL 32547-6706
Phone: (850) 862-2555
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 number1184594962
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jennifer Lord — Office Manager · (850) 862-2555
NPI enumeratedNovember 7, 2025
Last updated in NPPESApril 20, 2026
Certification dateApril 20, 2026
Mailing address914b Mar Walt Dr, Fort Walton Beach, FL 32547-6706

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