Brian Walter Petersen, D.O.
Orthopaedic Surgery in Manchester, TN. Individual provider (NPI-1).
NPI number1861693095
StatusActive
Last updated in NPPESSep 30, 2025
Details
- NPI
- 1861693095
- Entity type
- Individual (NPI-1)
- Name
- Brian Walter Petersen
- Credential
- D.O.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 28, 2007
- Certification date
- Sep 30, 2025
- Last updated
- Sep 30, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207X00000X | Orthopaedic Surgery | 2291 | TN | Yes |
| 207X00000X | Orthopaedic Surgery | TL1160 | WY |
Practice location
482 Interstate Dr Ste 102Manchester, TN 37355-3485
Phone 931-488-8700 · Fax 931-735-6456
Mailing address
111 Mosby CtShelbyville, TN 37160-7179
Other practice locations
730 Kings Ln
Tullahoma, TN 37388-5371
Tullahoma, TN 37388-5371
Phone 931-841-9200 · Fax 931-841-9216
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