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
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Enumeration date
12/27/2021
Last updated
02/03/2022
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