Board of Medical Examiners

 

Forms

  1. Declaration of Citizenship (PH-4183)
  2. Declaration of Eligibility for Expedited Licensure Process for a Military Member (PH-4279) 
  3. Declaration of Eligibility for Expedited Licensure Process for a Spouse of a Military Member (PH-4280) 
  4. Request for Duplicate License (PH-4058)
  5. Name and Address Change Request 
  6. Affidavit of Retirement (PH-3460)
  7. Inactivation Form (PH-4270) 
  8. Reporting of Convictions of Physicians
  9. Petition for Declaratory Order
  10. Request for Advisory Ruling
  11. Public Record Request Form

Applications for licensure as a Medical Doctor

 Applying for initial licensure from your professional licensing board has become a bit easier.  The Department of Health has implemented an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions.  The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check.  You will also be able to upload many of the documents required to complete your initial application!  Please go to the initial application link below to begin the online process.

  1.  Application for Medical Doctor Licensure in Tennessee  (Paper Application)
  2.  Application for a Special Training License as a Medical Doctor (Paper Application)
  3.  Application for Licensure Reinstatement 
  4. Renewal Application
  5.  Application for Special Volunteer License 
  6.  Application for Volunteer Health Care Services

Portability Act for Military and Military Spouse with transfer Orders to Tennessee

Please fill out the application below and email to Medical.Health@tn.gov with a copy of the military orders

Interstate Medical Licensure Compact 

 The Interstate Medical Licensure Compact (IMLC) is an alternative pathway to medical licensure for physicians seeking to practice medicine in multiple states. The IMLC creates a streamlined process for obtaining multiple state licenses. Applicants for licensure through the IMLC must meet the rigorous qualifications for licensure which are established under the compact. 

Tennessee is one of more than twenty states participating in the IMLC. For a complete list of participating states, minimum applicant qualifications, and information how to apply for licensure through the IMLC, please visit the Interstate Medical Licensure Compact Commission website at www.imlcc.org

Office Based Surgery

Genetic Counselors

► Applying for initial licensure from your professional licensing board has become a bit easier.  The Department of Health has implemented an online application process that will allow all health care professionals to apply online for an initial license and complete (and update as necessary) a practitioner profile mandatory for certain professions.  The process is user friendly and convenient and even allows you to pay for your initial application utilizing a credit card, debit card or e-check.  You will also be able to upload many of the documents required to complete your initial application!  Please go to the initial application link below to begin the online process.

Radiologist Assistant