Get License No. 164025, Dugald Lewis, M.d.. Board Order - W3 Health State Ny

This guide provides clear, step-by-step instructions on how to accurately complete the License No. 164025, Dugald Lewis, M.D.. Board Order form online. Following these instructions will aid users in ensuring compliance and understanding of the requirements involved in the license restoration process.

Follow the steps to accurately complete the online form.

1. Press the ‘Get Form’ button to download the form and open it in your preferred editing tool.
2. Begin by entering the applicant's name, 'Dugald Lewis', and his current address, including '570 Lebrun Road, P.O. Box 2002, Amherst, New York 14226.' Ensure the format matches the requirements specified in the form.
3. Review the case number noted on the form, '01-50-60,' and ensure it is correctly captured in the designated field.
4. Enter the details regarding the previous license status, noting that the license was revoked effective October 18, 1997, as described in the documentation attached to the application.
5. Respond to each question about the reasons for seeking restoration. Provide any supporting documentation or proof of rehabilitation, including evidence of continuing medical education (CME) and personal statements.
6. Ensure to cite any recommendations from professional peers or supporting references that endorse the restoration of the license.
7. After completing the form, carefully review all entered information for accuracy and settle any discrepancies.
8. Save the completed document, then download, print, or share the form as required by the application process.

Complete your restoration application online to take the next steps toward regaining your medical license.