Provider Demographics
NPI:1578505764
Name:GOLD, BRAD SCOTT (AUD)
Entity type:Individual
Prefix:
First Name:BRAD
Middle Name:SCOTT
Last Name:GOLD
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 N COMMONS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7940
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:630-303-5385
Practice Address - Street 1:2700 N O'CONNOR
Practice Address - Street 2:STE. 102B
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75062-5698
Practice Address - Country:US
Practice Address - Phone:972-252-9360
Practice Address - Fax:972-252-7516
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51392231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80297AOtherBCBS IND PROV ID #
TX8F4883Medicare PIN