{
"Npi": {
"NPI": "1548773682",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BERGEN",
"FirstName": "WILLIAM",
"MiddleName": "HENRY",
"NamePrefix": null,
"NameSuffix": "IV",
"Credential": "R.PH",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1466 MANATEE CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TARPON SPRINGS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "34689-5884",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "813-505-2139",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1840 MEASE DR STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAFETY HARBOR",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "34695-6603",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "727-499-0085",
"PracticeLocationAddressFaxNumber": "727-499-0142",
"EnumerationDate": "11/12/2017",
"LastUpdateDate": "11/12/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "PS33869",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}