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MD/DO Administrative License Application

MD/DO Administrative License Application

For Doctors of Medicine (MD) and Doctors of Osteopathic Medicine (DO) seeking an administrative license. Administrative licensees may not provide medical or clinical services to or for patients.

At a glance: An administrative license is for non-clinical or management roles only. Applications are submitted online through MELS (Mississippi Enforcement and Licensure System).

Fee: $550, payable after submission. View full fee schedule.

License validity: If issued by the Board prior to March 31, the license expires June 30 of the current year. If issued on or after April 1, the license expires June 30 of the following year.

Renewal: Annually.

Important rules before you start

Online Application Timeline. Your online application stays active for 90 days from the date the Board receives each verification from an outside institution. Each new verification received resets the 90-day window, up to a maximum of 365 days total from the date of submission. If the application is not completed and the license is not issued within 365 days, the application will be considered null and void, and a new application must be submitted along with all required fees and certifications. The 365-day time limit cannot be waived under any circumstances.

Application Progress. Once submitted, applicants may track progress through MELS (Mississippi Enforcement and Licensure System).

Incomplete Application Fee. A one-time $50.00 fee will be assessed if MSBML staff discover during application review that the application is not complete. This includes, but is not limited to: any public record not disclosed on the application (for example, prior name changes or prior arrests), or unreported segments of training (for example, training completed in part at one facility and in part at another must list both facilities and the time spent at each).

Refund Policy. No refunds will be issued under any circumstances.

FCVS Accepted. The Board accepts as primary source verification the Federation Credentials Verification Service (FCVS) from the Federation of State Medical Boards (FSMB). For more information, contact FSMB at www.fsmb.org.

Administrative License only

Applicants must sign and notarize an Administrative Statement attesting that they will not provide medical or clinical services to or for patients while in possession of an administrative license in the State of Mississippi.

Items Submitted by the Applicant

Submit these items upon completion of the online application and fees. Download the application instructions PDF below to use as a printable checklist.

PDFMD/DO Licensure Application InstructionsReference · Print and use as a checklist
ABirth Certificate or PassportCertified or notarized copy. If your name differs from your birth certificate, submit supporting documents (legal name change, marriage certificate, divorce decree, etc.). See Notary Guidelines and Form.
BMedical School DiplomaCopy of the original. Uploaded online during the application.
CDriver’s LicenseCopy of current license. Uploaded online during the application.
DTranslated Foreign Language DocumentsCertified English translation by a recognized translator. See Notary Guidelines and Form for accepted notarized copy formats. U.S. medical schools may submit original and translated medical school diplomas on behalf of an applicant.
PDFE. Affidavit and Perpetual Release FormSigned and notarized. The ORIGINAL must be mailed to the Board. A copy must be included with each hospital privilege form sent to a hospital. PDFF. Administrative StatementRequired for Administrative License only. Signed and notarized.
GPhotograph (physical and electronic)Passport-type photo taken within the last 60 days, in two forms: (1) physical wallet-sized print attached to the Affidavit, and (2) electronic copy uploaded via MELS. See Photograph Guidelines.
HApplicant FingerprintsTwo options: (1) FD-258 fingerprint cards mailed by the Board to your address, or obtained from a local law enforcement agency or fingerprinting service provider, completed and returned to the Board; or (2) LiveScan at MSBML, scheduled by the Board after application review and approval. See Fingerprinting Options.

Verifications Requested by the Applicant (Primary Source)

MSBML is a primary source verification board. The following verifications must be sent directly from the issuing institution to the Board.

PDFAppendix A (Education Certification)Primary source · Sent by each medical school attended PDFAppendix B (Post-Graduate Training Certification)Primary source · Sent by each internship, residency, or fellowship institution. PDFAppendix C (Activity Certification)Primary source · Each activity for the past 5 years must be verified. PDFAppendix D (State Medical Board Licensure Certification)Primary source · Each state in which you hold or have held a license. VeriDoc accepted. PDFAppendix E (Staff Membership Certification)Primary source · Hospital or staffing privileges held within the past 5 years.

Examination and Credential Reports

The following reports are requested by the applicant but sent to the Board directly by the testing body.

  • Examination Report: FLEX/SPEX/USMLE from FSMB; COMLEX/COMVEX from NBOME.
  • NBME / NBOME Certifications: If applicable, transcripts from usmle.org or nbome.org.
  • ABMS/AOA Certification: If 10+ years since medical licensing exam.
  • ECFMG Verification: Required for graduates of international medical schools.
  • Military Records: DD-214 Form for any military service.

How to Apply

  1. Register in MELS

    First-time applicants create a username and password in MELS (Mississippi Enforcement and Licensure System).

  2. Request your primary source verifications

    Send Appendix A through E (as applicable) to each issuing institution.

  3. Complete and submit the online application

    Log in to MELS, complete each section, upload your applicant-side documents, and pay the application fee.

  4. Mail your Affidavit, Administrative Statement, and physical items

    Mail the ORIGINAL notarized Affidavit and Perpetual Release Form, the notarized Administrative Statement, the wallet-sized photo attached to the Affidavit, and completed fingerprint cards to the Board.

  5. Track your application in MELS

    Track progress in MELS (Mississippi Enforcement and Licensure System).

Fee

$550, payable after submission of the online application. No refunds will be issued under any circumstances. A one-time $50.00 incomplete-application fee may be assessed.

For the full breakdown of all MSBML licensing fees, see the Fee Schedule.

Questions?

Email the licensing professional at mboard@msbml.ms.gov. Format the subject line as: License Type + Applicant’s Full Name.

By phone: 601.987.3079.

Ready to apply?

Have your forms ready, then start your application in MELS.

← Back to Apply

Mississippi Administrative Code: For complete rules governing this license type, see Mississippi Administrative Code, Part 2610 (Physician and Podiatrist rules) on our Laws, Code & Policies page.