Board of Podiatric Medicine

General Inquiries

Board of Podiatric Medicine
3605 Missouri Boulevard
P.O. Box 1335
Jefferson City, MO 65102-1335
573.751.0873 Telephone
573.751.6301 Fax
800.735.2966 TTY
800.735.2466 Voice Relay
podiatry@pr.mo.gov
https://pr.mo.gov/podiatrists.asp

Change of Address

Licensees please provide the State Board of Podiatric Medicine with any change in your business and/or mailing 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.

You must fill out all required fields.

Name as it appears on your license

Last Name:

First Name:

Middle Initial:

License Number:

Additional Information

Email:

Telephone Number (inluding area code):

Effective Date of Changes:
_{Changes dated in the future won't be changed until the date noted.}

Please indicate whether you want information sent to your mailing or business address.

This address will be printed on your license and also public.

Mailing Business

New Mailing Address

Street:

City:

State:

Zip Code:

Telephone Number (inluding area code):

New Business Address (Area for additional business addresses below)

Name

Street:

City:

State:

Zip Code:

Telephone Number (inluding area code):

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

New Additional Business/Branch Address

Name

Street:

City:

State:

Zip Code:

Telephone Number (inluding area code):

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)}

Name

Street:

City:

State:

Zip Code:

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.

Please type the numbers displayed above in the box below.

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)

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General Inquiries

Board of Podiatric Medicine

Change of Address

Name as it appears on your license

Additional Information

New Mailing Address

New Business Address (Area for additional business addresses below)

New Additional Business/Branch Address

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

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