Quantity:
Total Price:
x Price Per Unit: $30.00 =
Format: CD-ROM
Upon receipt of payment, the medical directory will be sent to the mailing address listed below. For your convenience, in
addition to direct payments by check or money order, the Board accepts Visa, MasterCard and American Express. If you wish to
pay by credit card, please indicate the method of payment below:
*Medical Directories may also be purchased and picked up at the Board's office from 8am to 5pm. (Please call ahead for
expedited service.)
Arizona Medical Board
Arizona Regulatory Board of Physician Assistants
1740 W. Adams St, Suite 4000 Phoenix, AZ 85007
Phone (480) 551-2700 www.azmd.gov
Date:
Cardholder Signature:
(If different from billing address)
Zip:State:City:Mailing Address:
Office Phone:
(Required)
Zip:State:City:Billing Address of Cardholder:
Name as Shown on Payment Card:
(No dashes between numbers)
Expiration Date:
Card Number:
AmexMastercardVisa
Type of Card:
MEDICAL DIRECTORY ORDER FORM
The Arizona Medical Board and the Arizona Regulatory Board of Physician Assistants annually produces a Medical Directory on
CD-ROM. The Directory contains an alphabetical listing of physicians and physician assistants. The CD-ROM allows searches for
physicians and physician assistants by name, city, and/or specialty. If you would like to purchase a copy, it is available for $30.
You may also perform an electronic physician or physician assistant search at www.azmd.gov or www.azpa.gov.
Please Note: The Arizona Medical Board will only accept credit card payment via mail (US, FedEx, UPS, or any other mail
carrier). Any credit card information received via any other method will not be processed and will be destroyed.
Requestor Name:
I am a licensed AZ physician
(CD-ROM provided free of charge to licensed physicians)
(Required)
For receipt, please include an e-mail address for submission.
E-mail:
