Change of Name

In order to update your name, you must submit your request in writing and provide appropriate documentation verifying the name change such as a copy of your marriage license, divorce decree or other legal document.

Please include your full name, address, and license number and return your request to:

State Board of Podiatric Medicine
PO Box 1335
Jefferson City, MO 66102-1335
Fax: (573) 751-0873

A duplicate license with the updated information will be mailed to you.