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To apply for licensure as an Allopathic Physician (MD) in the state of Nevada,
please choose
one of the following:
1.
Click here
to download the Board's printable application form (pdf), which includes detailed instructions.
Complete and mail to the Board at the address provided on the application form.
-OR-
2.
Click here
to complete the online Uniform Application for Physician State Licensure
through the Federation of State Medical Boards.
Physician Application for Special Purpose Licensure
(July 1, 2011 - June 30, 2013)
To apply for licensure as a Special Purpose Allopathic Physician (MD) in the state of Nevada,
download this printable form (pdf), which includes detailed instructions.
Physician Application for Special Volunteer Medical
License
To apply for licensure as a Special
Volunteer Allopathic Physician (MD) in the state of Nevada,
download this printable form (pdf), which includes detailed instructions.
Physician
Application for Special Event Medical License
To apply for a Special
Event Medical License (MD) in the state of Nevada,
download this printable form (pdf), which includes detailed instructions.
Physician Application for Status Change (2011
- 2013)
To apply for status change from inactive to active status as an
Allopathic Physician (MD) in the state of Nevada, download this printable form
(pdf), which includes detailed instructions.
Physician Application for Licensure Reinstatement
(2011 - 2013)
To apply for reinstatement as an Allopathic Physician (MD) in the state of Nevada,
download this printable form (pdf), which includes detailed instructions.
Resident Application for Limited Medical License
To apply for
licensure as a Resident in the state of Nevada, download this printable form
(pdf), which includes detailed instructions.
Rotating
Resident Application for Limited Medical License
To apply for
licensure as a Rotating Resident in the state of Nevada, download this printable form
(pdf), which includes detailed instructions.
Physician Assistant Application for Licensure
(July 1, 2011 - June 30, 2013)
To apply for licensure as a Physician Assistant in the state of Nevada, download
this printable form (pdf), which includes detailed instructions.
Pre-Licensure Notification of Supervision of Physician
Assistant form for Physician Assistant Applicants for Licensure
If you are not currently licensed as a Physician Assistant in the state of
Nevada, please use this form. (pdf)
Post-Licensure Notification of Supervision of Physician
Assistant form for Licensed Physician Assistants
If you are a licensed Physician Assistant in the state of Nevada, please use
this form. (pdf)
Physician Assistant Application for Licensure
Reinstatement
(2011 - 2013)
To apply for reinstatement as a Physician Assistant in the state of Nevada,
download this printable form (pdf), which includes detailed instructions.
Practitioner of Respiratory Care Application for Licensure
(July 1, 2011 - June 30, 2013)
To apply for licensure as a Practitioner of Respiratory Care in the state of
Nevada, download this printable form (pdf), which includes detailed
instructions.
Blood gas licenses are issued by the Bureau of Health Care Quality and
Compliance. You can contact that agency by calling 800-225-3414 (toll free) or
775-687-4475.
Practitioner
of Respiratory Care Application for Licensure
Reinstatement (March
1, 2010 - February 29, 2012)
To apply for reinstatement as a Practitioner of Respiratory Care in the state of Nevada,
download this printable form (pdf), which includes detailed instructions.
Use this form if your license was suspended March 1, 2010.
Practitioner
of Respiratory Care Application for Licensure
Reinstatement (July
1, 2011 - June 30, 2013)
To apply for reinstatement as a Practitioner of Respiratory Care in the state of Nevada,
download this printable form (pdf), which includes detailed instructions.
Use this form if your license was suspended July 1, 2011.
Perfusionist Application for Licensure
(July 1, 2011 - June 30, 2013)
To apply for licensure as a Perfusionist in the state of
Nevada, download this printable form (pdf), which includes detailed
instructions.
Perfusionist Application for Licensure Reinstatement
(2011 - 2013)
To apply for reinstatement as an Perfusionist in the state of Nevada,
download this printable form (pdf), which includes detailed instructions.
Authorization for Criminal Background
Investigation
This form must be completed and submitted with an application for licensure as
an Allopathic Physician (MD). as a Physician Assistant, as a Practitioner of
Respiratory Care or as a Perfusionist in the state of Nevada. Download this
printable form (pdf), complete, and submit the form with the application.
Notification of Collaboration with Advanced
Practitioner of Nursing
To notify the Nevada State Board of Medical Examiners of collaboration with
an Advanced Practitioner of Nursing, download this printable form (pdf).
Notification of Address Change
To notify the Nevada State Board of Medical Examiners of a change of
mailing address, download this printable form (interactive pdf), complete and mail
to the Nevada State Board of Medical Examiners at P.O. Box 7238, Reno, NV
89510-7238. Please note: The address you provide will be
available to the public.
Notification of
Name Change
To notify the Nevada State Board of Medical Examiners of change of name,
download this printable form (interactive pdf), complete and mail
to the Nevada State Board of Medical Examiners at P.O. Box 7238, Reno, NV
89510-7238.
Request for Wall Certification or Wallet ID Card
You must submit a copy of your
photo ID with your request in order to verify your identity to ensure your
information is released only to you.
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