Every record at the Division contains two addresses:
- Address of Record: This is the address that appears on your license/registration and is public record.
- Confidential Address: This address is not public record.
Licensees have the option of selecting either one as their mailing address.
Any change in your address of record or your mailing address can be reported to the Board by updating the information online or mailing a signed, written request. If you have moved or otherwise changed one or both of these addresses since your last license/registration was issued, you must notify the Board as soon as possible.
The Board also maintains business phone numbers and e-mail addresses for those that wish to provide them. The business phone number you provide will be part of your public record. The e-mail address you provide may be used by the Board to send correspondence to you. This e-mail address is not a public record. These may also be updated online.
There is no fee required to update any of the contact information in your Board record. If you wish to have a license re-printed to reflect the address changes you have made, a fee of $10.00 is required.
If you prefer to submit changes to your address offline, please mail a signed, written request to:
Board of Medicine
PO Box 83720
Boise, ID 83720-0063
PHONE NUMBER & E-br MAIL ADDRESS
The Division also maintains business phone numbers and e-mail addresses for those who wish to provide them. The business phone number you provide will be part of your public record. The e-mail address you provide will be used by the Board and Division staff to send correspondence to you. Your e-mail address is not a public record.
There is no fee required to update any of the contact information.
INDIVIDUAL NAME CHANGES
The individual name that appears on your license/registration must be your legal name. If it is not, you need to update your record by filling out a Name Change Affidavit and submitting it with the proper documentation (i.e., a marriage license, divorce decree, or court document noting name change) to the Division.
UPDATING YOUR LICENSE
** You will not receive a copy of your license/registration bearing the updated information until the next renewal period unless you submit the name change form along with the required documentation prior to renewing online.
DIRECTING PHYSICIAN UPDATE
Please complete the form Directing Physician Registration Form & AT Service Plan or Protocol Forms to update directing physician changes.
Idaho Code requires each licensed athletic trainer to notify the Board within thirty (30) days of any change in the status if their directing physician. Failure to do so is grounds for disciplinary action.
Change Notification Directing Physician – AT Service Plan/Protocol Form
Disclosure Statement for Inquiry on Impact of Criminal Conviction Form
Group Voucher Instructions
New License Application
Primary Source Verification
Request for Duplicate License Form
Request for License Verification Form
LINKS and OTHER INFORMATION