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.

US MEDICAL LICENSING
2303 n 44th Street
Suite 14-1076
Phoenix, AZ 85008
Phone (615) 733-2754

STATEMENT OF ACCURACY

I attest that all information submitted to US Medical Licensing is true and correct to best of my knowledge. No attempt has been made to omit, mislead, disguise or with hold any pertinent information required for licensure purposes. This also includes any questions related to: malpractice suites, whether named, settled or pending; actions take against my medical licensure or hospital privileges; drug or alcohol addictions, impairment programs or psychiatric therapy, current or past; sanctions or assessments due to insurance reimbursements, alleged Medicare or Medicaid fraud; misdemeanor or criminal record and expungement; post graduate training, including clinical clerkships, problems or incidents; and any child support obligations.

I understand that incorrect and omitted information may result in additional research time and expenses by US Medical Licensing. Inaccurate information will inhibit the speed in which the application process is handled by the board of medicine. I agree that USML will hold no liability for this delay.

Please answer YES/NO (if YES, please attach an explanation) the state boards may require additional documentation.

	Have you had any actions, loss, denial, probation, suspension restrictions, limitation, and revocations of license?
	Have you ever been named in any malpractice suits, current/past? Please provide a brief synopsis of each.
	Have you ever had any actions, loss, denial, probation, restrictions, limitations, revocations of staff privileges/employment or training?
	Have you had any arrests and/or convictions, including misdemeanors?
	Do you have any alcohol, drug, rehab, or ethical violations in your history?
	Have you ever been hospitalized in the last two years for any reason?
	Have you ever received mental treatment or therapy?

Malpractice carrier, address and/or phone number
Malpractice attorney, address and/or phone number

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