MEDICARE: DR. JOHN MANUEL SIMOES DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0000X	Sports Medicine Podiatrist	DPM00312	RI
2	213E00000X	Podiatrist	DPM00312	RI
3	213ES0103X	Foot & Ankle Surgery Podiatrist	DPM00312	RI

General Provider Information

NPI Number	:	1780633081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MANUEL SIMOES DPM

Provider Business Mailing Address
First Line	:	407 EAST AVE STE 120
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-5299
Country	:	US
Telephone Number	:	401-726-7777
Fax Number	:	401-727-1212

Provider Business Practice Location Address
First Line	:	407 EAST AVE STE 120
Second Line	:
City	:	PAWTUCKET
State	:	RI
Zip	:	02860-5299
Country	:	US
Telephone Number	:	401-726-7777
Fax Number	:	401-727-1212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2006
Last Update Date	:	01/26/2026

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