Individual
DR. GREGORY T FOSSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8900 N KENDALL DR, MIAMI, FL 33176-2118
(786) 596-1960
Mailing address
400 RANDY LN, FORT MYERS BEACH, FL 33931-4014
(215) 429-8358
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
MD046162L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001272293
—
PA
05
—
7608209
—
NJ
01
—
ME121321
FLORIDA STATE MEDICAL LICENSE
FL
Enumeration date
07/19/2006
Last updated
03/17/2018
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