Active NPI
Brent Zane Bergen
- Pharmacist
- Fort Worth, TX
National Provider Identifier
1073115523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 28723
- Practice address
- 4400 Bryant Irvin Rd
Fort Worth, TX 76132-1064 - Phone
- (817) 989-1931
- NPI assigned
- Nov 10, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28723 | TX | Primary |
Addresses
Primary practice location
4400 Bryant Irvin Rd
Fort Worth, TX 76132-1064
Mailing address
6605 Saddle Ridge Rd
Arlington, TX 76016-2537
Phone (817) 233-7863
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28723 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604966400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1604966400000",
"number": "1073115523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6605 SADDLE RIDGE RD",
"city": "ARLINGTON",
"state": "TX",
"postal_code": "760162537",
"telephone_number": "817-233-7863",
"fax_number": "817-989-1937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4400 BRYANT IRVIN RD",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761321064",
"telephone_number": "817-989-1931"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERGEN",
"first_name": "BRENT",
"middle_name": "ZANE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-11-10",
"last_updated": "2020-11-10",
"certification_date": "2020-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TX",
"license": "28723",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.