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General NPI Number Information
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NPI Number | 1578531216
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Entity Type | Individual
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Provider Name | JEFFERY TRAD WADSWORTH MD, FACS
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 12902 USF MAGNOLIA DR
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City | TAMPA
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State | FL
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Zip | 33612-9416
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Country | US
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Telephone | 813-745-7365
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Fax | 813-449-8618
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Provider Business Mailing Address
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Address Line | PO BOX 198441
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City | ATLANTA
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State | GA
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Zip | 30384-8441
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Country | US
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Telephone | 813-745-7365
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Fax | 813-449-8618
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 0101231639
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 0101231639
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | 0101231639
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207YX0901X
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Taxonomy Name | Otology & Neurotology Physician
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License Number | 0101231639
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME129920
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License Number State | FL
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