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First Name
Last Name
Email
Phone Number
Rank
Professor
Consultant
Resident Doctor
Medical Officer
Specialities
General Practitioner
General Surgery
Dermotology
Immunology
Radiology
Family Medicine
Internal Medicine
Neurology
Cardiology
Obstetrics
Gynacology
Opthalmology
Haematology
Paediatrics
Psychiatrics
Rheumatology
Oncology
Urology
Radiology
Endocrinolgy
Orthopaedics
Plastic Surgery
Gastroenterology
Dental Surgery
Maxillofacial surgery
ENT
Nephrology
Years of Experience
Languages
English
Pidgin
Hausa
Yoruba
Igbo
Fulfulde
Tiv
Kanuri
Ibibio
Practice License/Certificate of Registration
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Folio Number
Sex
Male
Female
Address
State and LGA
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Abia
Adamawa
AkwaIbom
Anambra
Bauchi
Bayelsa
Benue
Borno
Cross River
Delta
Ebonyi
Edo
Ekiti
Enugu
FCT
Gombe
Imo
Jigawa
Kaduna
Kano
Katsina
Kebbi
Kogi
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
Current Workplace
Referral Code
Social Media Links (separated by comma)
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