Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Brian Walter Petersen, DO

Individual provider Orthopaedic Surgery Physician · NPI 1861693095

Brian Walter Petersen, DO is an Orthopedic Surgery in Manchester, Tennessee. Graduated from At Still University of Health Sciences, College of Osteo Med, Kirksville in 2004, 22 years ago. Practices with Coffee Medical Group LLC, a 23-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Tennessee and Wyoming.

Years since qualifying
22
Trained at
At Still University of Health Sciences, College of Osteo Med, Kirksville
Licensed in
TN, WY
In the registry since
2007
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

See every abbreviation used in this directory →

Practice location Address checks out

482 Interstate Dr Ste 102
Manchester, TN 37355-3485
Phone: (931) 488-8700
Fax: (931) 735-6456
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 730 Kings Ln, Tullahoma, TN 37388-5371 — (931) 841-9200

Specialties & licences

Orthopaedic Surgery Physician (primary) Taxonomy 207X00000X · Licence 2291 (TN)
Orthopaedic Surgery Physician Taxonomy 207X00000X · Licence TL1160 (WY)

Record details

NPI number1861693095
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedMay 28, 2007
Last updated in NPPESSeptember 30, 2025
Certification dateSeptember 30, 2025
Mailing address111 Mosby Ct, Shelbyville, TN 37160-7179

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyORTHOPEDIC SURGERY
Medical schoolAT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
Graduated 2004 (22 years in practice)
Group practice Coffee Medical Group Llc — 23 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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