Registration and Certificate system

Home - Doctor Registration

Doctor Registration - no NPI

Doctor Information

Salutation

First Name

Middle Name

Last Name

Suffix

Web Site (do not forget https://)

password

repeat password

Security Question 1

Security Answer 1

Security Question 2

Security Answer 2

Office Phone

Cell Phone

Home Phone

Degree

Licensed states
Alabama	Alaska	Arizona
Arkansas	California	Colorado
Connecticut	Delaware	District of Columbia
Federal Service	Florida	Georgia
Guam	Hawaii	Idaho
Illinois	Indiana	Iowa
Kansas	Kentucky	Louisiana
Maine	Maryland	Massachusetts
Michigan	Minnesota	Mississippi
Missouri	Montana	Nebraska
Nevada	New Hampshire	New Jersey
New Mexico	New York	North Carolina
North Dakota	Ohio	Oklahoma
Oregon	Pennsylvania	Puerto Rico
Rhode Island	South Carolina	South Dakota
Tennessee	Texas	Utah
Vermont	Virginia	Washington
West Virginia	Wisconsin	Wyoming

Specialties (Please select all that apply)
Aerospace Medicine	Abdominal Surgeons	Academy of Pharmaceutical Physicians and Investigators	Acute care
Acute medicine	Addiction Medicine	Adolescent medicine	Aesthetic Plastic Surgery
Allergology	Allergy Asthma & Immunology	Ambulatory care	Andrology
Anesthesia	Anesthesiology	Angiology	Athletic training
Audiology	Auxology	Aviation medicine	Bariatrics
Biomedical scientist	Cardiology	Cardiopulmonary rehabilitation	Cataract and Refractive Surgery
Child & Adolescent Psychiatry	Chiropractic neurology	Chirpractic Medicine	Clinical Oncology
Clinical Pathology	College health	Colon and Rectal Surgery	Conservation medicine
Cosmetic Surgery	Critical Care Medicine	Cytopathology	Dentistry
Dermatologic Surgery	Dermatology	Digital pathology	Disaster medicine
Diving medicine	Emergency Medicine	Endocrinology	Environmental medicine
Epileptologist	Facial Plastic and Reconstructive Surgery	Family Medicine	Foot and Ankle Surgery
Gastroenterology	Gastrointestinal Endoscopy	Gender-based medicine	General practice
General Surgery	Geriatrics	Gerontology	Gynecologic Laparoscopy
Gynecology	Hand Surgery	Hematology	Hepatology
Hip & Knee Surgery	Hospice and Palliative Medicine	Hospital medicine	Immunology
Infectious Diseases	Insurance Medicine	Intensive care medicine	Internal Medicine
Interventional Pain Physicians	Interventional Radiology	Laparoendoscopic Surgery	Legal Medicine
Maxillofacial Surgeons	Medical Genetics	Medical statistics	Military medicine
Nephrology	Neuroimaging	Neurology	Neuromuscular and Electrodiagnostic Medicine
Neurophysiology	Neuroradiology	Neurosociology	Neurosurgery
Neurotology	Nuclear Medicine	Nursing	Obstetrics
Occupational and Environmental Medicine	Oncology	Ophthalmic Plastic and Reconstructive Surgery	Ophthalmology
Optometry	Oral and maxillofacial surgery	Oral medicine	Orthopaedic Surgery
Osteopathic Medicine	Otolaryngology	Pain Medicine	Paleopathology
Palliative medicine	Pathology	Pediatric Surgery	Pediatrics
Performance Medicine	Pharmaceutical medicine	Photomedicine	Physical Medicine and Rehabilitation
Plastic Surgery	Podiatry	Predictive medicine	Preventive Medicine
Psychiatry	Psychosomatic medicine	Public Health	Pulmonology
Radiation Oncology	Radiation therapy	Radiology	Rehabilitation medicine
Reproductive Medicine	Rheumatology	Serology	Sexual medicine
Sleep Medicine	Spine Surgery	Sports medicine	Thoracic Surgery
Toxicology	Transplantation medicine	Tropical medicine	Urogynecology
Urology	Vascular Surgery	Wilderness medicine

Back to the menu