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/Address 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.

ADDRESS CHANGES

Every record at the Board contains 2 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 the Board of Medicine, PO Box 83720, Boise, ID 83720-0063.

PHONE NUMBER & E-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 in your division record.

** 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.

NOTE: If you have an Idaho Controlled Substance Registration, please remember to change your contact information with the Board of Medicine and also on your PDMP account.

Application

PHYSICIAN & SURGEONS APPLICATION

MEDICAL RESIDENT APPLICATION (Intern and Resident Registration)

INTERVIEW – Information regarding the interview process.

Impact on Criminal Conviction Form

Click to Check Application Status.

$200 application fee must be paid to process the application. License fees due after application is approved.

Per the requirements of the FBI, fingerprint cards can only be mailed to and returned from the applicant’s personal address.

**Processing time for an application is dependent on the Applicant and proper submission of the on-line application with the required documents/documentation.

The application form for physicians and Surgeons requires the following:

The current mental and physical condition of the applicant, together with disclosure of any previous physical or mental illness which impacts the applicant’s ability to practice medicine;
The disclosure of any past or pending medical malpractice actions against the applicant, and the judgments or settlements, if any, of such claims exceeding $250,000;
The disclosure of any disciplinary action by any board of medicine, licensing authority, medical society, professional society, hospital, medical school, or institution staff in any state or country;
The disclosure of the refusal to issue or renew a license to practice medicine by any state, Canadian or international licensing authority;
Status of service in the U.S. military-active U.S. Military, honorably discharged U.S. Military veteran, or spouse of either one;
A certified copy of a full set of the applicant’s fingerprints on forms supplied by the Board which shall be forwarded to the Idaho State Police and to the FBI Identification Division for the purpose of a fingerprint-based criminal history check of the Idaho central criminal database and the Federal Bureau of Investigation criminal history database;
Each state, country and jurisdiction in which the applicant has applied for a license to practice medicine;
Each state, country and jurisdiction wherein the applicant is licensed to practice medicine; and
Such other information or examinations as the Board deems necessary to identify and evaluate the applicant’s credentials and competency.

Residence in Idaho is not required of any applicant; however, each applicant must be legally able to work and live in the United States. Original documentation of lawful presence in the United States must be provided upon request. The Board will refuse licensure or the renewal of a license if the applicant is not lawfully present in the United States.

The Board may refuse licensure if it finds that the applicant has engaged in conduct prohibited by Section 54-1814, Idaho Code. The Board will take into consideration the rehabilitation of the applicant and other mitigating circumstances.

Each applicant shall speak, write, read, understand and be understood in the English language. Evidence of proficiency in the English language must be provided upon request.

Each applicant must have graduated from an acceptable school of medicine, and passed an examination acceptable to the Board that demonstrates qualification for licensure or have successfully completed the United States Medical Licensing Exam (USMLE) and completed one (1) year of postgraduate training approved by the ACGME, AOA or Royal College of Physicians and Surgeons of Canada. Every applicant shall submit a completed written application to the Board with the nonrefundable application fee. Any certificate or document required to be submitted to the Board which is not in the English language must be accompanied by a certified translation into English.

If you have questions, please contact the Division at (208) 327-7000 or HP-Licensing@dopl.idaho.gov.

Uniform Application for Physicians – Please note that FCVS is not required for Idaho. This link will take you to the website of the Federation of State Medical Boards (FSMB). If you are having problems with the FSMB site, please contact them at (817) 868-4000.

Physician Re-Entry After Absence From Practice– Information on return to practice following clinical inactivity for a “period exceeding one (1) year, or when practice has been significantly interrupted.

In 2003, the Idaho Legislature created the Idaho Rural Physician Incentive Program (RPIP) to encourage primary care physicians to practice in medically under-served areas of the state. The law established the Rural Physician Incentive Fund, which is funded by fees assessed to all Idaho students participating in the WWAMI and University of Utah state supported medical education programs. Eligible physicians can apply to receive a RPIP award for qualified medical education debt repayment. For additional information visit the Idaho Department of Health and Welfare Rural Health Care Access and Physician Incentive Program webpage.

Renewal

Online Renewal Log-In

NOTE: Due to Apple security restrictions, Licensees will need to make setting changes to complete the renewal process using Safari on an Apple device. Instructions provided after log-in.

Group Voucher: For facilities intending to pay for the renewal of multiple licenses.

Please Note: For Check/Money Order payments, print your receipt and mail it with your payment or give to the individual paying for the renewal. An invoice will not be mailed.

Renewals paid by check/money order are not complete until payment is received. Partial payments for group vouchers will be returned to sender. Please include license number on check/money order and mail with receipt to:

Idaho Board of Medicine
PO Box 83720
Boise, ID 83720-0063

Other questions or problems? Email our staff at HP-Licensing@dopl.idaho.gov

Active Military: If you are active military and requesting a renewal fee waiver, please email the Board at HP-Licensing@dopl.idaho.gov

Please note: If you fail to renew your license before its expiration date a reinstatement fee will be required by Idaho Code 67-2614 and cannot be waived. In addition, you may be required to submit continuing education or other required documentation prior to the reinstatement of your license.

If you want to reinstate an expired license, please email our licensing staff at HP-Licensing@dopl.idaho.gov

Name

Position

Expiration

Original Appointment

Michele Chadwick

Public Member

July 1, 2026

August 22, 2014

Kedrick Wills

Director ISP

July 3, 2017

Mark Steven Grajcar

D.O.

March 17, 2025

May 8, 2017

David A. McClusky III

July 1, 2025

May 8, 2017

Paula Phelps

Physician Assistant

March 17, 2025

July 15, 2019

Keith Davis

MD–Pulmonary

July 1, 2025

July 12, 2019

Guillermo Guzman Trevino

MD–OB-GYN

July 1, 2029

March 11, 2021

Jared C Morton

MD– Emergency

July 1, 2027

November 1, 2021

Paul E Anderson

Public Member

July 1, 2025

May 3, 2022

Thomas Neal

MD — Neurology

March 17, 2028

September 26, 2022

Christian G Zimmerman

July 1, 2029

July 1, 2023

Active/Inactive License
OSTEOPATHIC PHYSICIAN AND SURGEON
ADMINISTRATIVE FEE – PAPER RENEWAL	$20.00
LICENSE REINSTATEMENT FEE – CURR YR	$100.00
LICENSE RENEWAL FEE – CURR YR	$200.00

OSTEOPATHIC PHYSICIAN AND SURGEON – INACTIVE
ADMINISTRATIVE FEE – PAPER RENEWAL	$20.00
LICENSE REACTIVATION FEE	$100.00
LICENSE REINSTATEMENT FEE – CURR YR	$100.00
LICENSE RENEWAL FEE – CURR YR	$100.00

OSTEOPATHIC PHYSICIAN AND SURGEON – VOLUNTEER
ADMINISTRATIVE FEE – PAPER RENEWAL	$0.00
LICENSE RENEWAL FEE – CURR YR	$0.00

PHYSICIAN AND SURGEON
ADMINISTRATIVE FEE – PAPER RENEWAL	$20.00
LICENSE REINSTATEMENT FEE – CURR YR	$100.00
LICENSE RENEWAL FEE – CURR YR	$200.00

PHYSICIAN AND SURGEON – INACTIVE
ACTIVE / INACTIVE DIFFERENTIAL	$100.00
ADMINISTRATIVE FEE – PAPER RENEWAL	$20.00
LICENSE REACTIVATION FEE	$100.00
LICENSE REINSTATEMENT FEE – CURR YR	$100.00
LICENSE RENEWAL FEE – CURR YR	$100.00

PHYSICIAN AND SURGEON – VOLUNTEER
ADMINISTRATIVE FEE – PAPER RENEWAL	$0.00
LICENSE RENEWAL FEE – CURR YR	$0.00

PRIMARY DIRECTING PHYSICIAN
LICENSE RENEWAL FEE – CURR YR	$0.00

SUPERVISING PHYSICIAN – COSMETIC AND LASER
LICENSE RENEWAL FEE – CURR YR	$0.00

APPLICATION
BOARD OF MEDICINE APP – MEDICAL RESIDENT
REGISTRATION FEE	$20.00

BOARD OF MEDICINE APPLICATION
APPLICATION FEE	$200.00
INITIAL LICENSURE FEE	$200.00

General Fees
DUPLICATE LICENSE FEE	$10.00
DUPLICATE WALL CERT FEE	$25.00
LICENSE VERIFICATION FEE	$20.00
MAILING LIST FEE	$100.00

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