Apply for Collaborating Physician - MainStreet Family Care

Apply for Collaborating Physician

Please fill out the form below and click Submit to submit your application for consideration. Fields with an asterisk (*) are required.

Summary
Title:	Collaborating Physician
ID:	PT-DR-NOGA-08.12.24
Department:	Operations
Location:	N/A

Resume
* Resume:	Supported formats: Word, PDF, RTF, Text, and HTML.

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Contact Information
* First Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:
Opt-In Confirmation
	I authorize recruiters from MainStreet Family Care to send text messages from 8556485172 with requests for additional information in relation to this job application only. Message/data rates apply. Message frequency varies.
Attachments
Cover Letter:	You can type in a Cover Letter or Copy/Paste from an existing document.

2024 Collaborating Physician

* 1. Are you a board-certified Medical Doctor?

	Yes
	No

* 2. Are you a board eligible Medical Doctor?

	Yes
	No

* 3. Do you have at least 3 years of experience as a Medical Doctor?

	Yes
	No

* 4. Have you ever had your credentialing status revoked by an insurance company?

	Yes
	No

* 5. Has your license to practice medicine ever been suspended or revoked?

	Yes
	No

* 6. Is your license currently in “good standing?”

	Yes
	No

* 7. Do you currently supervise any Nurse Practitioners?

	Yes
	No

* 8. If yes, how many?

* 9. When can you start?

* 10. Are you legally eligible to be employed in the United States? (Proof of identity and eligibility will be required upon employment)

	Yes
	No

* 11. Are you able to perform the essential functions of the job for which you are applying, with or without a reasonable accommodation?

	Yes
	No

* 12. Would your schedule allow for AT LEAST one in-clinic day every four weeks?

	Yes
	No