Provider Demographics
NPI:1629419650
Name:HYDRICK, ELIAS N (DO)
Entity Type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:N
Last Name:HYDRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 2 BOX 12343
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09012-0124
Mailing Address - Country:US
Mailing Address - Phone:713-962-0091
Mailing Address - Fax:
Practice Address - Street 1:RAMSTEIN AIR BASE
Practice Address - Street 2:BUILDING 2114
Practice Address - City:RAMSTEIN
Practice Address - State:RAMSTEIN-MIESENBACH
Practice Address - Zip Code:66877
Practice Address - Country:DE
Practice Address - Phone:314-479-1459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-06
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102204022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine