DOMINNO C FOGLE Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****32

License Status

ACTIVE

Business

First Name

DOMINNO

Middle

Last Name

FOGLE

Business Name

DOMINNO C FOGLE

Original Issue Date

11/01/2011

Effective Date

01/25/2024

Expiration Date

03/01/2026

City

NORMAL

State

Zip

61761

County

MCLEAN

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/03/2025