Update your MD / DO / DPM Profile

You can complete and update your Physician Profile online.

Address Change Information

Please log in to our Online Licensing system to update your address. 

 Name Change Information

All licensees/applicants wishing to change their name with the Board must submit their request using the Name and Address Change Form. Follow the instructions on the form when the required information is submitted.

You must submit a copy of a legal document verifying your new name. The following are acceptable name change verification documents:

• Marriage certificate; 
• Divorce decree which indicates the retaking of your maiden name;
• Other legal document indicating the retaking of your maiden name;
• Copy of court documents.