Organization
GENESISCARE USA OF FLORIDA LLC
Active
Parent organization
GENESISCARE USA INC.
Other names
Basil D Fossum MD
Organization subpart
Yes
Provider details
NPI number
Legal business name
GENESISCARE USA INC.
Authorized official
DAN COLLINS (PRESIDENT)
(239) 931-7275
Entity
Organization
Contact information
Practice address
914 MAR WALT DR, SUITE B, FORT WALTON BEACH, FL 32547-6706
(850) 226-6572
(850) 862-8564
Mailing address
2160 COLONIAL BLVD, FORT MYERS, FL 33907-1410
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
09/06/2011
Last updated
08/24/2020
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