State of Nevada

  Board of Medical Examiners

Application and Other Licensing Forms


Attention Physicians:

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.

 
 
APPLICATION FORMS
     
          Physician Application for Licensure (Mid-biennial)
     (July 1, 2008 - June 30, 2009)
            To apply for licensure as an Allopathic Physician (MD) in the state of Nevada,
              download this printable form (PDF File), which includes detailed instructions.

               Physician Application for License Renewal

            (2009 - 2011)

               To renew your license as an Allopathic Physician (MD) in the state of Nevada,

                  download this printable form (PDF File), which includes detailed instructions.

         Physician Application for Special Purpose Medical License
            (Mid-biennial) (July 1, 2008 - June 30, 2009)
            To apply for licensure as a Special Purpose Allopathic Physician (MD) in the 
               state of Nevada, download this printable form (PDF File), which includes 
              detailed instructions.
 

               Physician Application for Special Purpose License Renewal

            (2009 - 2011)

               To renew your license as an Allopathic Physician (MD) in the state of Nevada,

                  download this printable form (PDF File), which includes detailed instructions.

      
           Physician Application for Special Volunteer Medical License 
           To apply for a Special Purpose Medical License in the state of Nevada,
             download this printable form (PDF File), which includes detailed instructions.
 
        Physician Application for Status Change 
           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 File),
            which includes detailed instructions.
        Physician Application for Licensure Reinstatement
         (2007-2009)
           To apply for reinstatement as a Physician Assistant in the state of Nevada,
             download this printable form (PDF File), which includes detailed instructions.
 
         Physician Authorization for Criminal Background
            Investigation
           This form must be completed and submitted with an application for licensure as an
             Allopathic Physician (MD) in the state of Nevada.  Download this printable 
             form (PDF File), complete, and submit the form with the application.
        Resident Application for Limited Medical License 
         (July 1, 2009 - June 30, 2010)
           To apply for licensure as an a Resident in the state of Nevada, download this
              printable form (PDF File), which includes detailed instructions.
        Physician Assistant Application for Licensure (Mid-biennial)
        (July 1, 2008 - June 30, 2009)
            To apply for licensure as a Physician Assistant in the state of Nevada,
              download this printable form (PDF File), which includes detailed instructions.

               Physician Assistant Application for License Renewal

            (2009 - 2011)

               To renew your license as a Physician Assistant in the state of Nevada,

                  download this printable form (PDF File), which includes detailed instructions.

        Physician Assistant Application for Licensure
            Reinstatement  (2007-2009)
           To apply for reinstatement as a Physician Assistant in the state of Nevada,
             download this printable form (PDF File), which includes detailed instructions.

        Practitioner of Respiratory Care Application for Licensure

           (Mid-biennial)  (February 28, 2009 - February 28, 2010) 

              To apply for licensure as a Practitioner of Respiratory Care in the state of Nevada,

                download this printable form (PDF File), 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 (2008-2010)
           To apply for reinstatement as a Practitioner of Respiratory Care in the state of
             Nevada, download this printable form (PDF File), which includes detailed
             instructions.
 
            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 File).
 
          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 File).
 
          Notification of Address Change
          To notify the Nevada State Board of Medical Examiners of change of practice
            address, download this printable form (PDF File), complete and mail to 
             the Nevada State Board of Medical Examiners at P.O. Box 7238, 
             Reno, NV  89510-7238.
       

 

The Nevada State Board of Medical Examiners utilizes Adobe Acrobat for the distribution of electronic versions of its documents.
You must have Adobe Acrobat Reader installed on your computer to view these files.

RETURN TO BOARD OF MEDICAL EXAMINERS HOME PAGE


Home