PR License Verifications

Only Active Licenses can be verified. If the license is not Active - then DO NOT submit the order. Which Puerto Rico License Verification Service do you Require: *

Mailed Verification from PR Board - $279. This will include Issue Date.

Emailed Verification from PR Database - $199. This will NOT include issue date.

Puerto Rico Medical License Number - Required: *

Puerto Rico Medical Registry Number - Required (This is NOT the Puerto Rico License #): *

Profession ( MD, DDS/DMD, NP, PA, RN ) *

Full Legal Name (on Identity Documents and Medical School Diploma): *

Mailing Address: *

Phone Number: *

Doctor's Email: *

Date of Birth: *

Place of Birth: *

Social Security Number: *

Name of Institution Receiving Verification: *

Destination Mailing Address: *

Name of Person Requesting the Verification: *

Contact Phone Number:

Contact Email: *

Do you required a PR Examination Verification? *

Yes - ***If you check "YES" you will be charged an Additional $179.00

Credit Card Number:

Credit Card Expiration Date:

Credit Card 3-4 digit Pin # (on Back of the Card - VISA, MC, or Discover - on Front for AMEX)

Name on the Credit Card:

Billing Address of the Credit Card: