State Medical Board Applications & Forms Initial Applications Review the FAQs page for important information about applying for licensure and practicing in the State of Alaska. Physician (MD, DO, DPM) MD/DO Online application for licensure Filed through your MyAlaska account. Also allows for email notifications about your application status. Uniform Application (UA) for initial licensure Offered through the Federation of State Medical Boards (FSMB) to benefit physicians applying for licensure in multiple states. FSMB customer service: Phone 800-793-7939. Email: ua@fsmb.org MD/DO Paper Application for Initial Licensure #08-4105, Revised 09/20/2024Application for Physician Licensure in Alaska Application for Resident Permit #08-4022, Revised 09/20/2024 For resident physicians who wish to serve all or a portion of their residency training in Alaska. Application for Podiatrist License #08-4109, Revised 09/20/2024 Includes application for temporary permit. Application for Locum Tenens Permit #08-4021, Revised 09/20/2024 For medical and osteopathic physicians. Application Request for Extension of Locum Tenens Permit #08-4923, New 09/20/2024 For medical and osteopathic physicians. Application for Physician Courtesy License #08-4288, Revised 09/20/2024 Physician license for specific, limited purposes. Physician Assistant Physician Assistant - Certified, Online Application Filed through your MyAlaska account. Also allows for email notifications about your application status. The online application is available for certified physician assistants ONLY. To apply as a graduate physician assistant, utilize the paper application form linked below. Physician Assistant, Paper Application #08-4226, Revised 09/20/2024 Application for certified or graduate physician assistants. Physician Assistant Collaborative Plan #08-4892, Revised 09/20/2024 Authorization for Prescriptive Authority/Physician Assistant - Certified #08-0017, Revised 11/01/2024 Periodic Record of Assessment/Physician Assistant - Certified #08-4348, Revised 11/01/2024 Renewal Applications MD, DO, DPM License Renewal Application #08-0077, Revised 10/23/2024 Physician Assistant License Renewal Application #08-0079, Revised 10/23/2024 Click Here to Renew Online Online Applications available through MYAlaska Review the FAQ Page for important information about CME requirements for renewals, including the legislative requirement for education in pain management and opioid use and addiction. Miscellaneous Forms Online License Verification via VeriDoc Use if you need a verification of your Alaska physician license sent to another state medical board. The verification will be sent via computer - transfer of information occurs immediately. Periodic Record of Assessment/Physician Assistant - Certified #08-4348, Revised 11/01/2024 For collaborating physicians Medical Board Mandated Reporting Form #08-4864, New 08/15/2023 Physician-Pharmacist Cooperative Practice Agreement #08-4410, Revised 09/28/2023 Authorization for Prescriptive Authority/Physician Assistant - Certified #08-0017, Revised 11/01/2024 IHS Provider State Licensure Exemption#08-4853, New 05/04/2022 Request for Expedited Review #08-4664, Revised 12/28/2023 Division forms may be found in the CBPL Quick links, located in the sidebar to the right. Licensing Staff Contact Information Physicians and Physician Assistants whose last name begins with the letters A through F may contact:Licensing Examiner: Alisa Perkins Phone: (907) 465-1077 Email: alisa.perkins@alaska.gov Physicians and Physician Assistants whose last name begins with the letters G through N may contact: Licensing Examiner: Jacob Olsen Phone: (907) 465-2566 Email: jacob.olsen@alaska.gov Physicians and Physician Assistants whose last name begins with the letters O through Z may contact:Licensing Examiner: Roger Casquejo Phone: (907) 465-6278 Email: roger.casquejo@alaska.gov Medical licensing general contact: Email: medicalboard@alaska.gov