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Physician Licensure

Attention Applicant

Pursuant to NRS 630.167, as part of the application process, you are required to submit to a criminal background investigation. Upon receipt of your completed application, your License Specialist will send you an authorization form, the appropriate fingerprint cards, and instructions. 

Forms

Physician Application
Use this link to apply online for licensure as an allopathic physician (M.D.) in the State of Nevada.  If you are an osteopathic physician (DO), please contact the Nevada State Board of Osteopathic Medicine (www.osteo.state.nv.us) regarding licensure in the State of Nevada.
Application Checklist - Physician Application
Form 1 - Physician Application
Medical Education Verification
Form 2 - Physician Application
Postgraduate Training Verification
Form 3 - Physician Application
Verification of State Licensure
Form 4 - Physician Application
Malpractice Claim Verification
Form 5 - Physician Application
Hospital / Surgery Center Privileges Verification
Form A - Physician Application
Release
Form B - Physician Application
List of Malpractice Insurance Carriers
Form C - Physician Application
Request for Licensure by Endorsement
Form D - Physician Application
Request for Licensure by a Resident
Civil Applicant Waiver - Physician Application
Responsibility Statement - Physician Application
Physician Application by Endorsement - NRS 630.1607 and NRS 630.268(4)(a)
Use this form to apply for licensure as an allopathic physician (M.D.) in the State of Nevada pursuant to NRS 630.1607 and NRS 630.268(4)(a)
Physician Application for Special Volunteer Medical License
Use this link to apply online for licensure as a Special Volunteer Allopathic Physician (MD) in the state of Nevada.
Physician Application for Special Purpose Licensure
Use this link to apply online for licensure as a special purpose allopathic Physician (M.D.) in the State of Nevada.
Application Checklist - Physician Special Purpose License Application
Form 1 - Physician Special Purpose License Application
Medical Education Verification
Form 2 - Physician Special Purpose License Application
Postgraduate Training Verification
Form 3 - Physician Special Purpose License Application
Verification of State Licensure
Form 4 - Physician Special Purpose License Application
Malpractice Claim Verification
Form A - Physician Special Purpose License Application
Release
Form B - Physician Special Purpose License Application
List of Malpractice Insurance Carriers
Civil Applicant Waiver - Physician Special Purpose License Application
Responsibility Statement - Physician Special Purpose Application
Physician Application for Special Event Medical License
Use this link to apply online for a special event medical license (M.D.) in the State of Nevada.
Form A - Physician Special Event License Application
Release
Form B - Physician Special Event License Application
Hospital / Surgery Center Privileges Verification
Form C - Physician Special Event License Application
Verification of State Licensure
Responsibility Statement - Physician Special Event License Application
Physician Application for Status Change to Active
To apply for status change from inactive to active status as an allopathic physician (M.D.) in the State of Nevada (change effective during the 2021-2023 biennium), download this printable form (pdf), which includes detailed instructions.
Physician Application for License Reinstatement to Active or Inactive 2021-2023
Use this form to apply for reinstatement of your license.
Physician Application for License Reinstatement to Active - Authorized Facility, Research Restricted, County Restricted 2021-2023
Use this form to apply for reinstatement of your license.
Notification of Supervision of Physician Assistant
To notify the Nevada State Board of Medical Examiners of supervision of a physician assistant, download this printable form (pdf).
Notification of Collaboration with Advanced Practice Registered Nurse
To notify the Nevada State Board of Medical Examiners of collaboration with an advanced practice registered nurse, download this printable form (pdf).
Notice of Termination of Supervising and/or Collaborating Agreement
To notify the Nevada State Board of Medical Examiners of termination of supervision of a physician assistant or collaboration with an advanced practice registered nurse, download this printable form (pdf).

General Forms

Address Change Form
Name Change Form
License Verification Request Form
Replacement Wall Certificate Order Form
Petition for Review of Criminal History
Last date edited: 3/24/2022
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