Application For Medical Gas Distributor or Medical Gas Supplier/DME Permit

Instructions

Instructions

Business Information

Ownership Information

Other Business Information

Regulatory Questions

Designated Representative Information

Attachments

Review Your Information

Affirm And Submit

Please note that after you click the Submit button, you cannot make changes to your application.

Mailing Address: P.O. Box 18520, Phoenix, AZ 85005 Phone: (602) 771-2727