The urban medical delivery system includes not only the technological and scientific skills and apparatus used by health care practitioners but also those economic and social arrangements made by doctors that affect their ability to provide medical care. Among the most important of these is the location of health care facilities, especially doctors' offices. This paper traces the changing locations of doctors' offices in San Francisco between 1881 and 1941. Most specifically, it focuses on the separation of office from residence and the location of offices in the city. Changes in location began to occur during the urban transformation that occurred late in the nineteenth century. At that time, changes in the division of labor, the role of the family, and transportation and communications technology interacted with changes in science, medical technology and professional organization to alter the nature and location of the settings used to provide medical care. The health care delivery system is thus interpreted as the product of the overall dynamics of urbanization rather than the outcome simply of scientific discovery, medical technology and the influence of key medical practitioners and professional organizations.