Shane C. Fogo, M.D.
Family Medicine · Eureka, IL
UnclaimedM.D.NPI 1063446318
- Primary taxonomy
- 207Q00000X
- Enumerated
- 2006-07-11
- Practice location
- Eureka, IL
- Last NPPES update
- 2012-12-14
State licenses
- IL · Physician · LICENSED PHYSICIAN AND SURGEONActivethrough 2029
- IL · Resident physician · TEMPORARY MEDICAL PERMITInactivethrough 2005
“Listed on NPI record” means the provider reported this license to NPPES; other statuses come from the state board’s public records as of the last import. License numbers are not shown.
Source: CMS National Plan & Provider Enumeration System (NPPES) and state licensing boards. ScrubHub shows name, credential, taxonomy, practice city/state and license status only.