Dr. Weber

1. Specialty & Credentials

· Specialty: Physician-Neurology

· Board Certified/Eligible: Board Certified

· Total Years of Experience: Over 30 yrs

· Locums Experience: 3.5 yrs

· Clean Malpractice (Y/N): Yes,

2. Licensure

· State Licensed: Minnesota, Huwai

· IMLC: (Y/N) – (If Yes, we need a copy of LOQ letter): No

· NPI:

· DEA: (Active / Will Apply) Active

· Certifications: BLS / ACLS / PALS / ATLS (Please list) BLS

3. Availability & Commitment

· Tentative Start Date: Sept 25

· How many shifts per Week/Month: 5 shifts/week.

· Length of Assignment want to Commit (3/6 months): It depends on the work.

· Interview Availability (Best Days/Times to Contact for next 2 weeks): If client is interested then I’ll let you know.

4. Pay & Documents

· Expected Pay Rate: $300/hr

· Comfortable with discussed rate? (Y/N): Yes

5. Travel

· Travel Needed: Hotel / Flight / Rental Car (Y/N)