Physician Providers Candidate Profile

Overview of physician information

Name*
First Last
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary phone*
Home phone
Office phone
About you
I am a ...*
- Physician
- Physician Assistant
- Nurse Practitioner
If you have a specialty, list it here.
Indicate which applies:*
- Board certified
- Board eligible
- Neither
I will also consider positions in
- Emergency room
- Urgent care
List the states where your license is active.

Desired hourly compensation (locums) rate:
Desired permanent placement salary (annual):
What EMR software programs do you have experience with?
Exceptions
- Do you have problems with licensing or privileges?
- Any malpractice suits?
- Any past treatment for alcohol/drug abuse?
- Is there anything on your National Practitioner Database Report that would affect your placement?
If any of the following apply to you, please send details in a separate document emailed to appexceptions@physicianproviders.com
Is there a Reference ID you wish to include with your inquiry?
The Reference ID can be found next to "Apply Now" at the bottom of the job post.
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About you