SHANE C FOGO MD Medical Doctor License verification

Business Entity

NOT RENEWED

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****95

License Status

NOT RENEWED

Business

Title

First Name

SHANE

Middle

Last Name

FOGO

Business Name

SHANE C FOGO MD

Original Issue Date

06/19/2008

Effective Date

06/19/2008

Expiration Date

07/31/2011

City

EUREKA

State

Zip

61530

County

WOODFORD

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/05/2020