MEDICARE: BRAD SCOTT GOLD AUD

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	231H00000X	Audiologist	51392	TX
2	237600000X	Audiologist-Hearing Aid Fitter	51392	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80297A	OTHER	TX	BCBS IND PROV ID #

General Provider Information

NPI Number	:	1578505764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAD SCOTT GOLD AUD

Provider Business Mailing Address
First Line	:	750 N COMMONS DR STE 200
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-7940
Country	:	US
Telephone Number	:	630-303-5380
Fax Number	:	630-303-5385

Provider Business Practice Location Address
First Line	:	2700 N O'CONNOR
Second Line	:	STE. 102B
City	:	DALLAS
State	:	TX
Zip	:	75062-5698
Country	:	US
Telephone Number	:	972-252-9360
Fax Number	:	972-252-7516

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	08/06/2024

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Directions to “ BRAD SCOTT GOLD AUD” Practice Location

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