Change of Address

Licensees please provide the State Board of Podiatric Medicine with any change in your business and/or home addresses. You can use the form below to report address changes to your record and click submit or email the board at podiatry@pr.mo.gov.

Name as it appears on your license

Additional Information

New Home Address

New Business Address (Area for additional business addresses below)

Missouri licensed podiatrists are required to register with the board and display a license at all locations in which they are actively practicing.

New Additional Business/Branch Address

NOTE: If you have other business/branch addresses that you need to add to your record, please either submit another electronic form or email podiatry@pr.mo.gov and include that information.

Remove The Following Business Address From My Record
(If nothing noted here addresses already registered with the board will remain active)

NOTE: If you have other business/branch addresses that you need to remove from your record, please either submit another electronic form or email podiatry@pr.mo.gov and include that information.

Code

Only licensees should update their information. By submitting you are representing that you are the person whose information is being changed.

Or send a quick email to podiatry@pr.mo.gov (podiatry@pr.mo.gov)