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this is the provider identification page please review each question and answer all required questions required questions are marked with an asterisk some questions are not marked with an asterisk but may be required depending on each situation therefore please make sure to answer all questions if necessary the first section on this page is the provider legal information locate the field marked last name and input the providers last name then type out the providers first name in the first name field input the middle initial if necessary if you are only using your ssn the doing business as section may be skipped after you have completed the legal name information you will need to locate the gender drop down menu and select the appropriate gender of the individual provider from the drop down menu next to the right of the gender field input the providers date of birth after you completed the information begin scrolling down to answer the additional questions on this page next section i