NOTICE OF AGENCY
SUBSTANTIVE POLICY STATEMENT #3

The Arizona Board of Medical Examiners
9545 East Doubletree Ranch Road, Scottsdale, Arizona 85258

1. Title of the guidance document or subject of the substantive policy statement and the guidance document number or substantive policy statement number by which the document or policy statement is referenced:

Policy on the use of names other than the name on the physician's license. (SPS #3)

2. Date of the application of the guidance documents or the date the substantive policy statement was issued and the effective date of the document or policy statement if different from the publication or issuance date:

Originally Published Summer 1990, Revised May 1999.

3. Summary of the contents of the guidance document or the substantive policy statement:

Policy prohibiting a physician from practicing medicine using name(s) other than the name in which the license was issued.

4. A statement as to whether the guidance document or substantive policy statement is a new document or statement or a revision.

Revision

5. The name, address and telephone number of the person to whom questions and comments about the guidance document or substantive policy statement may be directed:

Deputy Director, Arizona Board of Medical Examiners
9545 East Doubletree Ranch Road Scottsdale, Arizona 85258
(480) 551-2700

6. Information about where a person may obtain a copy of the guidance document or the substantive policy statement and the costs for obtaining the document or policy statement:

Available from the Board of Medical Examiners.
Twenty-five cents per page copying cost.

ARIZONA BOARD OF MEDICAL EXAMINERS SUBSTANTIVE POLICY STATEMENT #3

Policy on the use of names other than the name on the physician's license It is a violation of the Medical Practice Act for physicians, while representing themselves as physicians in any way, to change, modify, or use a name other than the name that appears on their medical license.