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AFFILIATION LETTERS
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STAFF APPLICATION LOGIN
Affiliation Letter
As part of our effort to provide the medical community with Affiliation Letter for Medical Doctors currently on our staff, we have created this page that is intended to generate the letters securely and efficiently. To access this information, please call the Medical Office at (310) 836-7000 for the password.
Please enter the information required below and submit. You will receive a confirmation via e-mail.
Your Name*
Department
Your facility name*
Address 1:
Address 2:
City
State
Zip
Email
Phone
Please enter the physician's last name.
Hint: Not sure how to spell the doctor's name? Just type part of the name you know how to spell to see a list of possible doctors to choose from. For example, typing 'char' will find Charles, Charlston, Richard, etc.
For physicians currently members of our Medical Staff, simply search by providing the physician's last and first name as well as middle initial. Our affiliation letter can be printed immediately. If the physician in question is no longer on our Medical Staff, you will be prompted to contact us directly.
Login*
Password*
I have read and understand the below statement.*
Disclaimer and Confidentiality Notice Due to the high volume of requests for information, this service is provided only as a convenience to expedite the credentiating process. By accessing this site, you acknowledge the information provided by this service is confidential and that you have proper release from the physician to obtain such information. If you cannot locate a physician or if you have any questions, please contact the Medical Staff at Brotman Medical Center.