SHANE C FOGO MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN AND SURGEON

License Number

036111674

License Status

ACTIVE

Business

Title

First Name

SHANE

Middle

Last Name

FOGO

Business Name

SHANE C FOGO MD

Original Issue Date

06/23/2004

Effective Date

07/05/2023

Expiration Date

07/31/2026

City

EUREKA

State

Zip

61530

County

WOODFORD

Ever Disciplined

LastModifiedDate

07/05/2023