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- Address Change Form
Duty to notify Board of change of address: State of MS Administrative Code, Part 2610,Chapter 1; Part 2615, Chapter 1, Rule 1.10; Part 2620, Chapter 1, Rule 1.7;and Part 2625, Chapter 1, Rule 1.8 states that any physician, physician assistant, radiologist assistant, or acupuncturist who is licensed or receives a license to practice in this state and changes his or her practice location shall immediately notify the Board in writing of the change of location. Failure to notify within 30 days could result in disciplinary action.
- Name Change Form
- Duplicate Wall Certificate Request
- Duplicate Wallet Card Request
The Medical Board will no longer provide hard copies of wallet cards. You will receive an electronic copy.
- Background Check Form