Every licensee of the Medical Board is required by statute
to have on file with the Board their residence address and
their principle practice address, if they have one.
Each licensee is further required to report any change of
either address to the Board within 30 days of the change.
Please use this form
to notify the Medical Board of any address change.
Fill out the entire form below. When you have finished, please click the Submit button
to send your information to our Records Department.