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Get AF 1540 2004-2024

IRATION DATE DATE ISSUED EXPIRATION DATE SPECIALTY DATA SPECIALTY (List all specialties for which fully qualified) BOARD CERTIFICATION (Specialty Board) CERTIFICATE NUMBER FEDERAL DRUG ENFORCEMENT ADMINISTRATION (DEA)/STATE CONTROLLED SUBSTANCE REGISTRATION (CSR) FEDERAL DEA (Type) REGISTRATION NUMBER DATE ISSUED EXPIRATION DATE REGISTRATION NUMBER DATE ISSUED EXPIRATION DATE DoD Fee-Exempt Federal (Fee-Paid) STATE CSR (Name of State) VI. MEMBERSHIP IN PROFESSIONAL SOCIETIES (If ad.

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