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F. Medical License/Registrations
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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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MED_LIC_ID
MASTER_ID
NAME_OF_LIC_REG_JURISD
LICENSE_REGIST_NUM
SPECIALITY
STREET_ADDRESS_PO_BOX
STREET_ADDRESS_CONTINUED
CITY
STATE_PROVINCE
COUNTRY
POSTAL_ZIP_CODE
TELEPHONE_NUM
FACSIMILE_NUM
EMAIL_ADDRESS
LISCENSE_ISSUE_DATE
LICENSE_EXPIRATION_DATE
STATUS
Year Relinquished:
Obtained
field18
field19
⇒
1
tim2
State of Colorado
341234132
Ears
1313 Mocking Bird Lane
Denver
Co.
USA
80010
303.779.4568
303.779.9999
Co_Medical_license.org
05/08/2007
Active
2008
2
tim2
State of Colorado
341234132 testing
Ears
1313 Mocking Bird Lane
Denver
Co
USA
80010
303.779.4568
303.779.9999
Co_Medical_license.org
05/08/2007
Active
2008
3
tim2
State of Texas
341234132
05/08/2007
Active
2008
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MED_LIC_ID
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*
MASTER_ID
NAME_OF_LIC_REG_JURISD
LICENSE_REGIST_NUM
SPECIALITY
STREET_ADDRESS_PO_BOX
STREET_ADDRESS_CONTINUED
CITY
STATE_PROVINCE
COUNTRY
POSTAL_ZIP_CODE
TELEPHONE_NUM
FACSIMILE_NUM
EMAIL_ADDRESS
LISCENSE_ISSUE_DATE
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LICENSE_EXPIRATION_DATE
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STATUS
Active
Inactive/Expired
Pending
Relinquished
Year Relinquished:
Obtained
field18
field19