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

Basil D. Fossum

Individual provider Specialist · NPI 1821043811

Basil D. Fossum is an Urology in Fort Walton Beach, Florida. Graduated from University of California, San Francisco School of Medicine in 1972, 54 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
54
Trained at
University of California, San Francisco School of Medicine
Licensed in
FL
In the registry since
2006
Specialties on file
2
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Practice location Address checks out

914B Mar Walt Dr
Fort Walton Beach, FL 32547-6706
Phone: (850) 226-6572
Fax: (850) 862-8564
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Urology Physician (primary) Taxonomy 208800000X · Licence ME53505 (FL)
Specialist Taxonomy 174400000X · Licence ME53505 (FL)

Record details

NPI number1821043811
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMay 24, 2006
Last updated in NPPESJanuary 5, 2026
Certification dateJanuary 5, 2026
Mailing address914 Mar Walt Dr Ste B, Fort Walton Beach, FL 32547-6706

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyUROLOGY
Medical schoolUNIVERSITY OF CALIFORNIA, SAN FRANCISCO SCHOOL OF MEDICINE
Graduated 1972 (54 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Fort Walton Beach