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Search › Florida › 208800000X

Basil Fossum

NPI 1821043811 · on the registry since 2006 · sole proprietor

Practice

Address
914b Mar Walt Dr
Fort Walton Beach, FL 32547
Phone
(850) 226-6572
Fax
(850) 862-8564
Organisation at this address
Basil Fossum Md Pa
21st Century Oncology Llc
Inferred from a shared address, not stated in the registry.
Clinicians at this address
2

Registry record

Primary taxonomy
208800000X
208800000X
Also registered as
174400000X
Licence states on file
FL
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2026-01-05

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Florida