US Medical Licensing

For all your licensure amd credenitaling need assiting physicians in all 50 States - 615.618.4412 - 845.625.1540

Medical License

The process of obtaining a physician's state license is an endless stream of paperwork and procedures. Whether you are an established physician with a busy medical practice, or a overworked resident trying to complete your training, it is difficult to devote the time and energy that is required to research and complete the application process for your medical license.

Profile

State Licenses Request:
Specialty:
Full Name:
Maiden or Former Name:
Phone:
Fax:
Cell:
E-Mail Address:
Home or Express Delivery:
Address:

Social Security Number:
DOB:
Birth Place (city/state)
US Citizen: Y or N	Yes No
If no Status:
HEIGHT:
WEIGHT:
EYE COLOR:
HAIR COLOR:

High School Name:
Location:
Year of Graduation:
All Undergraduate Colleges Attended:
School Name:
Dates Attended:
Degree:
School Name:
Dates Attended:
Degree:
List All Attended:
Medical School:
Location:
Dates Attended:
Date of Obtaining Degree:
Degree:

Exams:
Name:
Part:
Date:
State Taken:
ECFMG:
Exam Date:
Cert #:
Date Certified:

Post Graduate Training:
Dates:
Intern/Resident/Fellow:
Location:

Post Graduate Training:
Dates:
Intern/Resident/Fellow:
Location:

STATE LICENSE EVER HELD:
STATE:
LICENSE NUMBER:
STATE:
LICENSE NUMBER:
FIRST LICENSE HELD:

PERSONAL REFERENCES:
NAME:
ADDRESS:
PHONE:
NAME:
ADDRESS:

Attach Copies of your diploma, training certificates, state licenses, board certificates, and CV. This will help expedite your license.
International Graduates ONLY: Please attach a list of all clinical rotations/clerkships. Also attach a copy of your transcripts.