MEDICARE: MR. BRADFORD B MELANCON M.S., CCC-A

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	237600000X	Audiologist-Hearing Aid Fitter	91059	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	531515	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1528057833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRADFORD B MELANCON M.S., CCC-A

Provider Business Mailing Address
First Line	:	7739 NORTHCROSS DR
Second Line	:	SUITE U
City	:	AUSTIN
State	:	TX
Zip	:	78757-1700
Country	:	US
Telephone Number	:	512-452-9200
Fax Number	:	512-452-9211

Provider Business Practice Location Address
First Line	:	7739 NORTHCROSS DR
Second Line	:	SUITE U
City	:	AUSTIN
State	:	TX
Zip	:	78757-1700
Country	:	US
Telephone Number	:	512-452-9200
Fax Number	:	512-452-9211

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	08/28/2009

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Directions to “ MR. BRADFORD B MELANCON M.S., CCC-A” Practice Location

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