Advanced Physicians' Insurance Risk Retention Group, Inc.

Advanced Physicians' Insurance Risk Retention Group, Inc.

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CONTACT INFORMATION
Name		Phone
Address		Fax
		Email
City		Confirm Email
State
Zip
PRACTICE INFORMATION
Primary Area of Practice
No Surgery Minor Surgery Major Surgery
Secondary Area of Practice
No Surgery Minor Surgery Major Surgery
Full Time Part Time Practice: Number of hours Year started part time
Sole Practitioner Group: Number physicians Corporation name
Percent of Practice Home Visits Assisted Living Visits Nursing Home Visits Office Visits Other (describe)
CURRENT POLICY INFORMATION
Current insurer		Policy expiration date
Retroactive date (if claims made)		# of years in practice
Number of years without a paid claim or notice of intent: 1-5 6-10 11-20
Limit of Liability: $100,000/$300,000 $200,000/$600,000 $250,000/$750,000

For additional information email us at:
mailto:info@advancedphysiciansinsurance.com
Advanced Physicians’ Insurance Risk Retention Group, Inc.
2700 N. Third Street
Suite 3050
Phoenix, AZ 85004
Phone: 877.286.2369
Fax: 602.297.6695