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
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Mailing Address - Street 1:7920 WYOMING BLVD NE
Mailing Address - Street 2:STE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6020
Mailing Address - Country:US
Mailing Address - Phone:505-821-6715
Mailing Address - Fax:505-821-0839
Practice Address - Street 1:101 S COIT RD
Practice Address - Street 2:STE 40
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5743
Practice Address - Country:US
Practice Address - Phone:469-461-8663
Practice Address - Fax:469-461-8667
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-05-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX51392237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80297AOtherBCBS IND PROV ID #
TX8F4883Medicare PIN