# SACRED HEART MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SHMG Destin OBGYN
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093482655
- **Authorized official:** JEAN VALLIER (DIRECTOR)
- **Authorized official phone:** (850) 267-2961

## Contact information

- **Practice address:** 7720 US HIGHWAY 98 W STE 310, MIRAMAR BEACH, FL 32550-7232
- **Practice address phone:** (850) 267-2961
- **Mailing address:** 4205 BELFORT RD STE 4015, JACKSONVILLE, FL 32216-3623

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 207VG0400X | Gynecology Physician | — | NULL | — |
| 207VG0400X | Gynecology Physician | — | — | — |
| 207VX0000X | Obstetrics Physician | — | NULL | — |
| 207VX0000X | Obstetrics Physician | — | — | — |

## Other

- **Enumeration date:** 08/23/2021
- **Last updated:** 08/23/2021