The Wyoming Board of Medicine will provide a list of licensees upon request to individuals or businesses who complete and submit the required form (found below) 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).)

Cost:

• • • Physicians Only: $500.00

    • Physician Assistants Only: $100.00

    • Physicians & Physician Assistants: $550.00

Request Form

Print, complete and mail this form with your payment:

List Request Form