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Arkansas State Medical Board fax number
(501) 603-3555
Licensing
Used for: Change of Address submission
Fax destination details
- Department
- Licensing
- Purpose
- Change of Address submission
- Form
- Change of Address — Change of Address Form
- Address
- Arkansas State Medical Board, 1401 West Capitol Avenue, Suite 340, Little Rock, AR 72201-2936
- Voice phone
- (501) 296-1802
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
IMPORTANT: Complete the Practitioner Information and BOTH Address sections. ALL sections must be completed even if information for one section has not changed. Return this form by Mail, Email (PDF only) or Fax as listed at the top of this page. This Office Will Not Process Incomplete Forms!
Official form instructions are published as a downloadable file on the organization's website.
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