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

Dr. Tyler Daniel Petersen, DO

Individual provider Orthopaedic Trauma Physician · NPI 1093102220

Dr. Tyler Daniel Petersen, DO is an Orthopedic Surgery in Vancouver, Washington. Qualified in 2017, 9 years ago. Practices with Northwest Surgical Specialists PC, a 117-clinician group and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
9
Licensed in
WA
In the registry since
2015
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.

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Practice location Address checks out

200 NE Mother Joseph Pl Ste 110
Vancouver, WA 98664-3293
Phone: (360) 254-6161
Fax: (360) 803-0847
Show map & directions

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

Specialties & licences

Orthopaedic Trauma Physician (primary) Taxonomy 207XX0801X · Licence OP61629112 (WA)

Record details

NPI number1093102220
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedApril 26, 2015
Last updated in NPPESNovember 21, 2025
Certification dateNovember 21, 2025
Mailing address200 Ne Mother Joseph Pl Ste 210, Vancouver, WA 98664-3295

Medicare enrollment

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

Medicare specialtyORTHOPEDIC SURGERY
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Northwest Surgical Specialists Pc — 117 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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