# MODERN GENTLEMEN MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Valley Express Med
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609536010
- **Authorized official:** MICHAEL MINCKLER MD (OWNER)
- **Authorized official phone:** (833) 436-8633

## Contact information

- **Practice address:** 8432 RAVENCREST ST, LAS VEGAS, NV 89139-6874
- **Practice address phone:** (206) 551-0154
- **Mailing address:** PO BOX 1992, YUMA, AZ 85366-2391

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QE0002X | Emergency Care Clinic/Center | — | NULL | — |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/27/2021
- **Last updated:** 02/03/2022