Database request form

* indicates a required field


Active status only
All statuses

MD - Medical Doctor
DO - Doctor of Osteopathy
L - Limited MD and Limited DO
PA - Physician Assistant
AA - Anesthesiologist Assistant
TA - Temporary Assistant (received before passing test)
SP - Special Purpose
RSV - Retired Senior Volunteer Program
ACSC - Alabama Controlled Substances Certificate
QACSC - Qualified Alabama Controlled Substances Certificate

No additional fields (just the base fields)

Phone (provided by licensee and not verified)
Fax (provided by licensee and not verified)
County
Gender
Date of death (Date of Birth Not Available)
Expiration date (Only for All Statuses. Active expiration is 12/31/current yr)
Issue Date date (Date the Alabama License was issued)
Original license date (Only if licensed first in another state)(MD, DO, L Only)
Original license source (Only if licensed first in another state)(MD, DO, L Only)
Medical school attended
Dates attended medical school
Status of the license (included only if you are asking for all statuses)
Primary specialty (provided by licensee, not verified)
Is board certified in primary specialty (provided by licensee, not verified)
Secondary specialty (provided by licensee, not verified)
Is board certified in secondary specialty (provided by licensee, not verified)
Public record (will receive a "Yes" or "No", no other information is included)
Has an ACSC/QACSC (will receive "Yes" if the licensee has an ACSC/QACSC)
NCC certified (only for PA or AA licenses)
NCC number (only for PA or AA licenses)

Use the Additional Information block below to include additional instructions.

For example, if you just want the list to include physicians located in certain cities or counties, then list those cities and counties in the additional instructions. Or if you want to just include physicians with certain specialties, list each specialty in the additional instructions. If selecting specific specialties, please make sure they are on our list of specialties.


 

 

This form uses Huggins' Email Form Script

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