MEDICARE: LAURIE RAE GREEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0000X	Obstetrics Physician	G34865	CA
2	207V00000X	Obstetrics & Gynecology Physician	G34865	CA
3	207VG0400X	Gynecology Physician	G34865	CA

General Provider Information

NPI Number	:	1679641658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE RAE GREEN M.D.

Provider Business Mailing Address
First Line	:	3838 CALIFORNIA ST
Second Line	:	316
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1522
Country	:	US
Telephone Number	:	415-379-9600
Fax Number	:	415-379-9823

Provider Business Practice Location Address
First Line	:	1375 SUTTER ST STE 105
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-5465
Country	:	US
Telephone Number	:	415-379-9823
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	04/07/2026

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Directions to “ LAURIE RAE GREEN M.D.” Practice Location

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