Healthcare Provider Details

I. General information

NPI: 1407388820
Provider Name (Legal Business Name): BRENDAN COUTU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E RIDGEWAY AVE STE CTC
WATERLOO IA
50702-5060
US

IV. Provider business mailing address

3421 W 9TH ST
WATERLOO IA
50702-5401
US

V. Phone/Fax

Practice location:
  • Phone: 319-272-2800
  • Fax: 319-272-2807
Mailing address:
  • Phone: 319-272-7304
  • Fax: 319-272-7318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301506379
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD-53681
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: