Basil D. Fossum, M.D., F.a.C.S.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

BASIL D. FOSSUM, M.D., F.A.C.S.

Doing business as

Dr. Fossum

Practice address

914 Mar Walt Dr Ste B
Fort Walton Beach, FL 32547-6706

Phone

(850) 266-5722

Fax

(850) 862-8564

NPI assigned

Sep 26, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

April Hughes

Title

Office Manager

Phone

(850) 226-6572

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Dr. Fossum Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607904000000",
    "number": "1235326026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "914B MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476706",
            "telephone_number": "850-862-2555",
            "fax_number": "850-862-8564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 MAR WALT DR STE B",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476706",
            "telephone_number": "850-266-5722",
            "fax_number": "850-862-8564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BASIL D. FOSSUM, M.D., F.A.C.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-26",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "APRIL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "850-226-6572"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "ME53505",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Fossum",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keilah Marie Barton, DO
• Sherri Barton, APRN
• J. Brent Bartruff, D.M.D.
• Svetlana Basenspiler
• Basil D. Fossum, M.D. PA (Basil D. Fossum, M.D.)
• Basil Fossum MD PA
• Adhithya Baskar, MD
• Bass Lake Inpatient Services, LLC
• Bassett Family Chiropractic Inc
• Timothy M Bassett, D.C.

• Urology Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Urology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.