By clicking Submit , I certify that the above information, the information provided on my Curriculum Vitae are complete and truthful as of this date, and I will request a self-query from the National Practitioner Data Bank and direct it to: Davis Health System, Attn: Lori Burnside, Medical Staff Liaison, P.O. Box 1484, Elkins, WV 26241. The Data Bank can be contacted via the Internet at: www.npdb-hipdb.com or NPDB Customer Service at: 1-800-767-6732. By clicking Submit it also authorizes the Davis Health System Physician Recruitment Staff or its Physician Leadership to contact as applicable my Residency and/or Fellowship Training Director and/or the following Professional References: Residency and/or Fellowship Training Director with Contact Information: