Provider Demographics
NPI:1780633081
Name:SIMOES, JOHN MANUEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MANUEL
Last Name:SIMOES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:407 EAST AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5299
Mailing Address - Country:US
Mailing Address - Phone:401-726-7777
Mailing Address - Fax:401-727-1212
Practice Address - Street 1:407 EAST AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5299
Practice Address - Country:US
Practice Address - Phone:401-726-7777
Practice Address - Fax:401-727-1212
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIDPM00312213E00000X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Not Answered213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery