Request for Duplicate Renewal Application

To obtain a renewal application, please provide the state board with the information requested below and click submit.

Licenses expire February 29, 2020. Unless renewed by the board office, the licensee is not authorized practice after that date.

Note: If you do not know your license number, go to the board's main web page https://pr.mo.gov/podiatrists.asp and click on LICENSEE SEARCH on the sub navigation. Leave the County Name and Profession Name fields set to ALL. Click on Licensee or Practitioner DBA Name and type your name in the text box provided. Be sure to enter your name specifically as requested (ie, Doe, John). Click the SEARCH button. When your license record is found, click on DETAIL to obtain the license number.

Name (Last, First M)
 

License Number

E-mail Address

E-mail Address (confirm)

Daytime Telephone Number

Fax Number (alternate delivery if email fails)

Mail To

Comments

Type name as electronic signature of request.

NOTE: ALL RENEWAL APPLICATIONS WILL BE SENT OUT IN THE FOLLOWING ORDER BASED INFORMATION PROVIDED: EMAILED TO THE EMAIL ADDRESS IF NO EMAIL IS PROVIDED, THE FORM WILL BE FAXED TO NUMBER PROVIDED. IF NEITHER ARE PROVIDED, THE FORM WILL BE MAILED TO THE ADDRESS PROVIDED.