Licensee List Request


Physician

Licensee list request

The Wyoming Board of Medicine will provide a list of licensees upon request to individuals or businesses who complete and submit the required form and payment via U.S. mail.  Make checks payable to  “Wyoming Board of Medicine”. 

Lists will be provided in Excel format and will be sent to the email address provided. 

Recipient agrees, upon receipt of the list, that the information contained will not be shared or sold to third parties.

Please allow three weeks from the receipt of your request to receive the requested list(s).

Information that will be included:

          Name and professional title of licensee       
          Public access address including city, state, zip
          License number
          License status
          Issue date
          Expiration date
          Board Certification
          Practice specialty

(List of available information set by W.S. § 33-26-408 and Board Rules, Ch. 6, § 3(a).)

 

Thank you for your interest.

 

 

 

 

 

 

 

 

 

 

 

 

Board of Medicine Licensee list request

Print this form and mail it with the required payment to:

Wyoming Board of Medicine
130 Hobbs Avenue Suite A
Cheyenne, WY  82002

Make checks payable to “Wyoming Board of Medicine”

 

List requested:
     □   Physicians only $500
     □   Physician Assistants only $100
     □   Both Physicians and Physician Assistants $550

 

Your information:

        Business name, address, and phone number

 


          Requestor’s name


          Email address

Mail form and payment to:

Wyoming Board of Medicine
130 Hobbs Avenue Suite A
Cheyenne, WY  82002

Your list(s) will be sent within three weeks of our receipt of your request.

Illegible or incomplete requests or requests without payment will be returned

Licensee information may not be shared or sold to third parties