BASIL FOSSUM MD PA
NPI 1184594962
Urology in Fort Walton Beach, FL
- Organization
- Urology
About BASIL FOSSUM MD PA
This page provides the complete NPI Profile along with additional information for Basil Fossum Md Pa, a provider established in Fort Walton Beach, Florida operating as a Urology. The healthcare provider is registered in the NPI registry with number 1184594962 assigned on November 2025. The practitioner's primary taxonomy code is 208800000X. The provider is registered as an organization and their NPI record was last updated April 2026. The organization operates as a Single Specialty Group with one or more individual practitioners, all of who practice with the same area of specialization. The authorized official of this NPI record is Jennifer Lord (Office Manager)
- NPI
- 1184594962 Verify this NPI
- Provider Name
- BASIL FOSSUM MD PA
- Entity Type
- Organization
- Location Address
- 914B MAR WALT DR FORT WALTON BEACH, FL 32547
- Location Phone
- (850) 862-2555
- Location Fax
- (850) 862-8564
- Mailing Address
- 914B MAR WALT DR FORT WALTON BEACH, FL 32547
- Mailing Phone
- (850) 862-2555
- Mailing Fax
- (850) 862-8564
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 11-07-2025
- Last Update Date
- 04-20-2026
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Urology
- Taxonomy Code
- 208800000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.
Group Taxonomy 193400000X SINGLE SPECIALTY GROUP
This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.
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Other Providers at the Same Location
The following 3 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1184594962, enumerated as an "organization" on November 07, 2025.
The provider is located at 914B MAR WALT DR FORT WALTON BEACH, FL 32547 and the phone number is (850) 862-2555.
Urology with taxonomy code 208800000X.
