Provider Demographics
NPI:1578531216
Name:WADSWORTH, JEFFERY TRAD (MD, FACS)
Entity type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:TRAD
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 198441
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-8441
Mailing Address - Country:US
Mailing Address - Phone:813-745-7365
Mailing Address - Fax:813-449-8618
Practice Address - Street 1:12902 USF MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-9416
Practice Address - Country:US
Practice Address - Phone:813-745-7365
Practice Address - Fax:813-449-8618
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231639207Y00000X, 207YP0228X, 207YX0007X, 207YX0901X
FLME129920207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006503004Medicaid
NC89064P3Medicaid
VAPAROtherCORVEL/CORCARE
VA294562OtherUHC/MAMSI
VA434684OtherANTHEM
VAPAROtherVA PREMIER HEALTH
VAPAROtherFIRST HEALTH COMMERCIAL
VAPAROtherCIGNA
VAPAROtherUSA MANAGED CARE
NC064P3OtherBC/BS
VAPAROtherVA HEALTH NETWORK
VAPAROtherMULTIPLAN
VA-004OtherTRICARE/CHAMPUS
VA41264OtherSENTARA
VAPAROtherAETNA
VA006503004Medicaid
VAPAROtherFIRST HEALTH COMMERCIAL
VA040016327Medicare PIN