APP Mailing Instructions
Before you return the application packet, please review all of your materials thoroughly for accuracy, completeness, signatures and dates. Please note that we cannot begin processing your application until the items listed below have been received, including all check boxes, blanks, and signatures completed.
- All professional licenses in California and other states
- DEA certificate (if applicable)
- Furnishing License (if applicable)
- Curriculum Vitae or Resume covering your work history for the last five years
- Malpractice Insurance Certificate and names of any other insurance carriers during the last five years.
- All supporting forms – Background Check Release, Code of Behavior Acknowledgement, Confidentiality And Conflict Of Interest, and Pharmacy Signature Sheet
- Application Fee of $150.00 per facility (non-employees only)
Mail the complete packet to:
Mailing Address: (*Use this address to mail via US Postal Service)
Medical Staff Services
300 Pastuer Dr, MC 5288
Stanford, CA 94305
Physical Location: (*Use this address to mail via UPS or FedEx or other courier service)
Medical Staff Services
1510 Page Mill Rd
Palo Alto, CA 94304
