Individual
BASIL D. FOSSUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME53505
FL
208800000X
Urology Physician
Primary
ME53505
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07317
BCBS FL
FL
01
—
1193041
WELLCARE
FL
01
—
159401
UNIVERSAL HEALTHCARE
FL
01
—
4266997
AETNA THRU EMERALD COAST HEALTH ALLIANCE
FL
01
—
593-08600
BCBS AL
FL
01
—
P00990540
RAILROAD MEDICARE
FL
Enumeration date
05/24/2006
Last updated
01/05/2026
Update your record
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