CollabMatch

I want to serve as a collaborating physician

Next, let's get a bit of info about who you are.

Your Profile

Professional Information

Legal first name

Legal last name

Year graduated medical school

Primary field of practice

Select Specialty

State of residence

Select State

Licensure & Eligibility

States of medical licensure

Select State(s)

States where you hold a DEA license

Select State(s)

Clinical Background & Collaboration Interests

Tell us about your clinical background, areas of focus, and your interests in collaborating with pharmacists.
This summary will appear on your public profile.

Introduce yourself

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Profile Photo

A professional photograph helps pharmacists recognize and connect with you.
You can update this anytime.

Drop image here or click to upload

Verification Details

NPI Number

Your NPI is used only for credential verification and won't be displayed on your profile or shared with pharmacists.

Private — Not shared publicly

Please enter your individual (Type 1) 10-digit NPI

Mobile Phone

Used only for secure account support and coordination. Your phone number will not be shared with pharmacists or patients.

Private — Not shared publicly

Please enter a valid phone number

Account Setup

You'll use this to sign in and manage your account.

Your email address

Confirm your email address

Create password

Confirm password

Attestation

I attest under penalty of perjury that I am currently a licensed physician, and that the information I have provided is true and accurate.

I agree to the Terms of Service of CollabMatch.