Provider Registration - Step 1 of 3
Licensing Information
To ensure security and data confidentiality, you must register to use Benefits Lookup.  It's a quick authentication process. Fill in the fields below to get started.
User ID (Used for future logins):     
Office TIN:   License Number:  
Doctor's First Name:   Doctor's Last Name:  
User's First Name:   User's Last Name:  
License State:  

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