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Organization
MODERN GENTLEMEN MD PLLC
Active
Organization
MODERN GENTLEMEN MD PLLC
Active
Other names
Valley Express Med
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL MINCKLER MD (OWNER)
(833) 436-8633
Entity
Organization
Contact information
Practice address
8432 RAVENCREST ST, LAS VEGAS, NV 89139-6874
(206) 551-0154
Mailing address
PO BOX 1992, YUMA, AZ 85366-2391
Taxonomy
Speciality
Code
Description
License number
State
261QE0002X
Emergency Care Clinic/Center
—
NULL
261QH0100X
Health Service Clinic/Center
—
NULL
261QU0200X
Urgent Care Clinic/Center
Primary
—
NULL
Other
Enumeration date
12/27/2021
Last updated
02/03/2022
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