IDEAL
Interoperability Development Effort to Authenticate Licensees
Select License Type
Physician's and Surgeon's
* Required
Select License Rank
* Required
Invalid Format: Numeric values only. Do not include license rank (e.g., A) selected above.
* Required
* Required
* Required
* Invalid Format: MM/DD/YYYY format; for example: 07/21/2025.
* Required
* Invalid Format. Numbers only.
*Required