| NPI | 1154911527 |
|---|---|
| Doing Business As | BASIL D. FOSSUM, M.D. |
| Entity Type | Organization |
| Authorized Contact | BASIL D. FOSSUM MD PA President 850-862-2555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2021-04-01 |