| Medical Commission Contact Information Change Form | |
| | | | Use this form for address, phone number, fax number or email changes to your medical credential. * Indicates required field | | | | Please select your credential type from the menu.
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| | | | Please provide your medical credential number. | |
| | | If you do not know your credential number, you may look it up using Provider Credential Search:
https://fortress.wa.gov/doh/providercredentialsearch/SearchCriteria.aspx | | | | |
| | Contact Information
The contact information you provide with this form is not considered releasable under public disclosure. | |
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