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State Medical Board

Applications & Forms

Attention Emergency Courtesy Licensee Applicants!

Effective July 1, 2022 no new ECL applications or ECL Extension applications will be accepted. Expedited temporary licensing is available with the full application process. Please email for more information.

Initial Applications

Review the FAQs page for important information about applying for licensure and practicing in the State of Alaska.

Physician (MD, DO, DPM)
Physician Assistant
Renewal Applications

Renewal applications will be available no later than December 1, 2022, in accordance with AS 08.01.050. Please note, you must wait for an updated renewal application to renew your license. You cannot renew your license using any prior renewal forms. If you need to renew your license for the current licensing period (1/1/2021 – 12/31/2022), email to request the appropriate form. To ensure receipt of renewal notifications and other correspondence from our office, please go to MY LICENSE and confirm your current mailing address is on file.

Prior to renewal, check out our License Renewal Prep guide.

If you are a Primary Collaborating Physician for Physician Assistant(s) and/or Sponsor Physician of Mobile Intensive Care Paramedic(s) get a head start by completing these forms prior to renewal.

For your convenience, these forms also available through your MY LICENSE account. Completed forms can be uploaded through MY LICENSE, see the instructions listed below for more details.

Review the FAQ Page for important information about CME requirements for renewals, including the legislative requirement for education in pain management and opioid use and addiction.

Miscellaneous Forms
Division forms may be found in the CBPL Quick links, located in the sidebar to the right.

Licensing Staff Contact Information

Physicians whose last name begins with the letters A through J, and Physician Assistants may contact:
Licensing Examiner: Jason Kaeser
Phone: (907) 465-2781

Physicians whose last name begins with the letters K through Q may contact:
Licensing Examiner: Jacob Olsen
Phone: (907) 465-2566

Physicians whose last name begins with the letters R through Z may contact:
Alisa Perkins
Phone: (907) 465-1077

Medical licensing general contact:
Phone: (907) 269-8163