provides a financial waiver of application fees for qualified applicants. If you qualify to apply as a Medical Doctor, you may be eligible for the waiver. Applicants must have a family income not exceeding 200% of the federal poverty guidelines. If you believe you qualify for the waiver, complete the application fee waiver form and provide the required documents
provides a financial waiver of application fees for qualified applicants. If you qualify to apply as a Medical Doctor, you may be eligible for the waiver. Applicants must have a family income not exceeding 200% of the federal poverty guidelines. If you believe you qualify for the waiver, complete the application fee waiver form and provide the required documents.
This form is to be completed by the applicant and is to be submitted for every application, permit or registration that is offered by the Arizona Medical Board,
with the exception of the renewal of license if citizenship has previously been established with the Board.
To order a CD-ROM containing the Physician and Physician Assistant Database, download this printable form which includes detailed instructions|(Providing an electronic medium containing public information about licensed physicians: $100.00*)
As a requirement for licensure in Arizona, United States citizens must provide a notarized copy of their birth certificate or notarized copy of their passport
in accordance with A.A.C. R4-16-201(C)(1). Non-citizens must provide proof of immigration status in accordance with A.R.S. § 41-1080 (see Evidence List) in addition
to a notarized copy of their birth certificate or passport, A.A.C. R4-16-201(C)(1).
<span>Misdemeanor offenses that have been determined to affect patient safety and are reportable under A.R.S. § 32-3208 by a licensee or license applicant.</span><br />
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<span>Other misdemeanors reportable under A.R.S. § 32-3208 besides those specifically listed within this document include any comparable charges filed against an Arizona licensee or license applicant by any other state, territory or country.</span>
"A.R.S. 32-1401(26)(gg) requires that a physician notify a patient of any financial interest in a separate diagnostic or treatment agency to which the physician is referring the patient."
The statute requires that a physician use this Board prescribed form.
To request public information, download this printable form which includes detailed instructions|(Providing a copy of records, doucuments, letters, minutes, applications, and files, $1.00 for the first three pages and $0.25 for each additional page*)
Note: This application may only be utilized if your license status is currently ‘Inactive’. You may not use this application if your license is currently Expired or Cancelled.
Misdemeanor offenses that have been determined to affect patient safety and are reportable under A.R.S. § 32-3208 by a licensee or license applicant.
Other misdemeanors reportable under A.R.S. § 32-3208 besides those specifically listed within this document include any comparable charges filed against an Arizona licensee or license applicant by any other state, territory or country.
Prior to submitting your request please read the following statutes regarding the qualifications of Inactivation or Cancelation of your Arizona medical license.