Employer Registration
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Employer Information
* Employer Type

* Employer Name

* Employer Tax ID

* Contact Email


* Primary Phone

Alternate Phone

Primary URL

Secondary URL

* Address1

* City

* State

* ZIP / Postal Code

NOTE: Person authorized by Employer ONLY should register the Employer with Physician Primary Care Plan.
Login Credentials
Note : Username must be between 6 and 16 characters.
* Username

Contact Information

Contact Details Add Contact Details

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