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BOARD OF MEDICINE
Online Address Changes
** You must enter your License/Registration Number and either the last four digits of your SSN/EIN or your Date of Birth **
In order to process your address changes you must provide us with your License/Registration number and either the last four digits of your SSN/EIN or your Date of Birth. Please be sure to enter your license/registration number as it appears on your License/Registration card.
License/Registration Number (Letters-Numbers)
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Last Four(4) Digits of Your SSN/EIN
OR
Date of Birth (mm/dd/yyyy)
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