Individual
RUSSELL SEAN PETRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22 CORPORATE PLAZA DR, NEWPORT BEACH, CA 92660-7901
(949) 722-7038
(949) 630-4935
Mailing address
22 CORPORATE PLAZA DR, NEWPORT BEACH, CA 92660-7901
(949) 722-7038
(949) 630-4935
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
G85402
CA
Other
Enumeration date
07/03/2006
Last updated
02/17/2020
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