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G. Hospital Affiliations:
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A. Master Personal Detailed Record:
C. Physical Data:
D. Board Certifications:
F. Medical License/Registrations
G. Hospital Affiliations:
H. Hospital Privileges:
I. Office Addresses:
J. Group Practice & Employment:
K. Medical School:
L. Medical Training:
M. Military Medical Training:
N. Professional Medical References:
O. Professional Associations:
P. Professional Liability Carrier:
Q. Disclosure questions:
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Hospital_Aff_id
Master_id
Primary_Other
Hospital_Name
Hospital_Address
Hospital_Address2
Hospital_City
Hospital_State
Hospital_Zip_Code
Hospital_Phone
Hospital_Fax
Department_Name
Department_Dir_Last
Department_Dir_First
Department_Dir_MI
Aff_St_Date
Aff_End_Date
Hospital_Affiliationscol
1
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qwer
qwer
asdf
asdf
12341`234
234646
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asdf
asdf
cxZxc
06/14/2007
08/17/2010
zxcvzxcvzxcv
0
tim2
wer
qwer
qwer
qwer
qwer
asdf
asdf
12341`234
234646
sfdasdf
asdf
asdf
cxZxc
06/14/2007
08/17/2010
zxcvzxcvzxcv
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