Provider Demographics
NPI:1811997901
Name:PROCTOR, LAUREN THERESA (MD)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:THERESA
Last Name:PROCTOR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMBARCADERO CTR STE 1900
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3723
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:
Practice Address - Street 1:2410 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2681
Practice Address - Country:US
Practice Address - Phone:888-663-6331
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78214207R00000X
CAG187560207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA69431OtherHPHC
MA102727OtherCIGNA
MA1293433OtherFALLON
MA2345680OtherAETNA
MA000000008364OtherBMC
MA24209OtherHNE
MA920161 05OtherUNITED HEALTH CARE
MAJ13319OtherBLUE CROSS & BLUE SHIELD
MA078214-7879OtherCONNECTICARE
MA6188044Medicaid
MA2345680OtherAETNA
MAA14291Medicare UPIN