- Application for Medical Resident/Intern
- Application for Physician and Surgeons
- Application Physician Re-entry After Absence from Practice
- BOM Request for Official Licensure Certification Form
- Criminal Conviction Disclosure Form
- Directing Physician Registration Form & AT Service Plan or Protocol Forms
- Duplicate License Application
- Inquiry on Impact of Conviction Form
- Medical Malpractice Prelitigation Claim Form
- Medical Personnel Supervising Physician Registration Form (including Cosmetic & Laser supervision)
- Name and Address Change Affidavit
LINKS and OTHER INFORMATION
Physicians and physician assistants may obtain primary source license verifications online through VeriDoc.
Request a Speaker
If you would like a member of the staff to speak to your organization or civic group please let us know. Include information on how we may contact you, the areas of interest and group/organization name. Click here to send us an email or call us at 208-327-7000.