SEE THIS SAMPLE FROM HEALTHPULSE:

Doctor Credential History Report
 
Name: John Smith
Credential: MEDICAL DOCTOR 
Address: 123 Main Street, Atlanta GA 30319
(770) 555-5555
Area of Practice: General Practice
Education: University of South Carolina 1970
Residencies: INTERNSHIP - NORTH CAROLINA BAPTIST HOSP NC - 05-07-1990 to 06-30-1992 UNKNOWN - WAKE FOREST UNIVERSITY NC - UNKNOWN to 10-30-1990
Government: ACTIVE DEA REGISTRATION AS OF 04-11-2003 - expires 02-29-2004
Drug Classifications
Schedule 1 Substances ( False )
Schedule 2 Narcotic Substances ( True )
Schedule 2N Non-Narcotic Substances ( True )
Schedule 3 Narcotic Substances ( True )
Schedule 3N Non-Narcotic Substances ( True )
Schedule 4 Substances ( True )
Schedule 5 Substances ( True )
Gender: MALE
Year of Birth: 1962

LICENSE SECTION
  License # 1 Issue Date: 1/1/2001
   Expiration Date: 12/31/2002
   Status: inactive
   State: GA
   License State:CA

LICENSE RELATED ACTION SECTION
  License related actions and items, including disciplinary actions, sanctions, consent orders, consent agreements, dismissals, non-disciplinary communications, advisory letters and other licensing information.
License Action # 1 Date: 01-30-2003
   State: GA
   Comments:
BOARD FINDING: DISHONORABE, UNETHICAL OR UNPROFESSIONAL CONDUCT WHICH IS LIKELY TO DECEIVE, DEFRAUD OR HARM THE PUBLIC OR ANY MEMBER THEREOF. BOARD ACTION: LICENSE PLACED IN A PROBATIONARY STATUS FOR TWO YEARS BEGINNING JANUARY 20, 2003, WITH CERTAIN RESTRICTIONS AND LIMITATIONS. COURT ACTION: DR. SMITH HAS FILED AN APPEAL OF THE BOARD'S ACTION IN THE CIRCUIT COURT AND HAS OBTAINED A STAY OF THE BOARD'S ACTION DURING THE APPEAL PROCEEDING.
   Source: Georgia Board of Medicine